Deaconess Clinic, Inc
Organization Active NPI Infectious Disease Physician · Evansville, IN
NPI 1861961138 · NPPES record last updated Oct 27, 2020
Key facts
- NPI
- 1861961138
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Infectious Disease Physician 207RI0200X
- Legal business name
- DEACONESS CLINIC, INC
- Practice address
- 350 W Columbia St Ste 440
Evansville, IN 47710-1782 - Phone
- (812) 450-8600
- Fax
- (812) 450-8151
- NPI assigned
- Nov 16, 2018
- Organization subpart
- No
Authorized official
- Name
- Cheryl Annette Wathen
- Title
- Cfo
- Phone
- (812) 450-3296
Corporate family (same tax ID) 17
Practitioners 1
-
Gina R Niemeier, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080922000145 | IN | Part B Supplier - Clinic/Group Practice | 3375610116 |
Receives reassigned benefits from 477 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Deaconess Clinc Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Infectious Disease Physician |
207RI0200X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
350 W Columbia St Ste 440
Evansville, IN 47710-1782
Mailing address
PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815
Other providers in Evansville, IN
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc.
- Deaconess Clinic, Inc.
- Deaconess Clinic, Inc.
- Deaconess Clinic, Inc.
All providers in Evansville, IN · Infectious Disease Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.