DEACONESS CLINIC INC NPI 1831345792

NPI Information

NPI: 1831345792
Provider Name: DEACONESS CLINIC, INC

Doing Business As: DEACONESS CLINIC I

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 15D0919558

Address:
106 W PIKE AVE
PETERSBURG, IN
ZIP 47567
Phone: (812) 354-1052
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DEACONESS CLINIC, INC is a rural health clinic center in Petersburg, IN. DEACONESS CLINIC, INC NPI is 1831345792. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Deaconess Clinic I.

The provider's business location address is:

106 W PIKE AVE
PETERSBURG, IN
ZIP 47567-750
Phone: (812) 354-1052
Fax: (812) 354-8280

The provider's authorized official is Cheryl A Wathen .
The authorized official title is Cfo and has the following contact phone number (812) 450-3296.

The CLIA number assigned to this NPI record is 15D0919558 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/12/2008 and was last updated on 8/10/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	363L00000X	Nurse Practitioner		No
3	261QR1300X	Clinic/Center	Rural Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	257900	MEDICARE PIN	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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