1720328685 NPI number — DEACONESS VNA PLUS, LLC

Table of content: (NPI 1720328685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720328685 NPI number — DEACONESS VNA PLUS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACONESS VNA PLUS, 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:
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:
1720328685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 HARRIET ST
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:
47710-1773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-425-3561
Provider Business Mailing Address Fax Number:
812-463-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 HARRIET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47710-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-425-3561
Provider Business Practice Location Address Fax Number:
812-463-4600
Provider Enumeration Date:
02/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GAMBLE
Authorized Official First Name:
LEIGH ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
812-450-3980

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  150123 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147311 . This is a "MEDICARE- ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 157004 . This is a "MEDICARE- INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 186268 . This is a "BLUE CROSS EVANSVILLE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 323485 . This is a "BLUE CROSS PRINCETON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 323484 . This is a "BLUE CROSS TELL CITY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: V255P (657A5)-1475 . This is a "VA PROVIDER- MARION, IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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