1245272921 NPI number — DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC

Table of content: (NPI 1245272921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245272921 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:
ANESTHESIA SERVICES AT THE WOMEN'S HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1245272921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2020
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:
812-842-4535

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:
812-842-4535
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CADY
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
812-842-4263

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  150028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 150028551 , 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: 207VM0101X , with the licence number: 150028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 150028551 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 150028551 , 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" .

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

  • Identifier: 65938615 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200378730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000188137 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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