1114297801 NPI number — DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC

Table of content: (NPI 1114297801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114297801 NPI number — DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114297801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4199 GATEWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47630-8940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-842-4200
Provider Business Mailing Address Fax Number:
812-842-4227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4199 GATEWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47630-8940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-842-4200
Provider Business Practice Location Address Fax Number:
812-842-4227
Provider Enumeration Date:
01/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
812-842-4222

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 130028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 170300000X , with the licence number: 74000008A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 01067142A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 05002666A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 140028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 130028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 130028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200871730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201046630A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201380400 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201003930 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201044710 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201046630B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200931070 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200934360 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200950810 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201386290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100319460 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201003570 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201118520 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200245730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200951280 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201395600A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".