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DEACONESS CLINIC INC NPI 1396040374


NPI Information

NPI: 1396040374
Provider Name: DEACONESS CLINIC, INC

Doing Business As: DEACONESS CLINIC, I

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 15D0361297

Address:
1204 WILLIAMS ST.
OAKLAND CITY, IN
ZIP 47660
Phone: (812) 749-6187
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DEACONESS CLINIC, INC is a family medicine in Oakland City, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DEACONESS CLINIC, INC NPI is 1396040374. 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:

1204 WILLIAMS ST.
OAKLAND CITY, IN
ZIP 47660-001
Phone: (812) 749-6187
Fax: (812) 749-4966

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 15D0361297 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/21/2011 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantNo
2363L00000XNurse PractitionerNo
3207Q00000XFamily MedicineYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1257900MEDICARE PININDIANA

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: 4/28/2024

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