Deaconess Memorial Medical Center Inc
Organization Active NPI Family Medicine Physician · Leavenworth, IN
NPI 1972877280 · NPPES record last updated Aug 27, 2025
Key facts
- NPI
- 1972877280
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS MEMORIAL MEDICAL CENTER INC
- Practice address
- 6402 E Industrial Lane
Leavenworth, IN 47137-8316 - Phone
- (877) 291-6488
- NPI assigned
- Mar 5, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- DEACONESS MEMORIAL MEDICAL CENTER INC
Authorized official
- Name
- Keith Miller
- Title
- Cao & Indiana Region President
- Phone
- (812) 996-0507
Other NPIs on the same Medicare enrollment 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081211000204 | IN | Part B Supplier - Clinic/Group Practice | 4587578042 |
Receives reassigned benefits from 26 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bristow, IN; French Lick, IN |
National Provider Directory
- Part of
- Little Company Hosp in Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
6402 E Industrial Lane
Leavenworth, IN 47137-8316
Mailing address
P O Box 1028
Jasper, IN 47547-1028
Phone (812) 996-8476
Other names
- Crawford County Family Medicine
Other providers in Leavenworth, IN
- Alana K Bartlett
- Black Pine Real Estate, LLC
- Extendicare Health Services
- Jill Fleace
- Harrison County Hospital
- Julie Hillenbrand Sellner
- Indiana Health and Rehabilitation Centers
All providers in Leavenworth, IN · Family Medicine 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 Aug 27, 2025. 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.