1710098405 NPI number — DEACONESS HOSPITAL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710098405 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:
1710098405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2008
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:
106 W PIKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47567-8750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-354-1052
Provider Business Practice Location Address Fax Number:
812-354-8280
Provider Enumeration Date:
08/31/2006

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: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 153843 . This is a "RURAL HEALTH #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • 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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