1023052883 NPI number — DEACONESS HOSPITAL, INC

Table of content: (NPI 1023052883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023052883 NPI number — DEACONESS HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACONESS HOSPITAL, INC
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:
1023052883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47733-3407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-6815
Provider Business Mailing Address Fax Number:
812-450-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47670-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-386-6560
Provider Business Practice Location Address Fax Number:
812-385-5015
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STIVERS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VICE PRESIDENT, CFO
Authorized Official Telephone Number:
812-450-3296

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CG1119 . This is a "RR MCARE GROUP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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