Deaconess Specialty Physicians, Inc
Organization Active NPI Cardiovascular Disease Physician · Olney, IL
NPI 1972004653 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1972004653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- DEACONESS SPECIALTY PHYSICIANS, INC
- Practice address
- 1400 N East St
Olney, IL 62450 - Phone
- (812) 450-7899
- Fax
- (812) 450-6029
- NPI assigned
- Feb 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Cheryl A Wathen
- Title
- Secretary/Treasurer
- Phone
- (812) 450-3296
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180523001150 | IL | Part B Supplier - Clinic/Group Practice | 0244595205 |
Receives reassigned benefits from 16 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Carmi, IL; Olney, IL; Mount Carmel, IL; MC Leansboro, IL; Fairfield, IL; Eldorado, IL |
National Provider Directory
- Tax ID family
- Deaconess Specialty Physicians Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes | ||
| Clinical Cardiac Electrophysiology Physician |
207RC0001X | |||
| Interventional Cardiology Physician |
207RI0011X |
Addresses
Primary practice location
1400 N East St
Olney, IL 62450
Mailing address
PO Box 1230
Evansville, IN 47706-1230
Phone (812) 450-7899
Other providers in Olney, IL
- Heather Nichole Curtis
- Pamela M Curtis
- Destiny R Dannells
- Charlotte Davies
- Deaconess Specialty Physicians, Inc
- Niranat Dejtiranukul
- Clark Edward Deshon
- Danielle Renee Deters
- Developmental Specialists of Southeastern Il, Inc.
- Luis C Devenecia Jr.
All providers in Olney, IL · Cardiovascular Disease Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. 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.