DEACONESS CLINIC, INC (NPI# 1639502859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639502859 |
| Entity Type | Organization |
| Organization Name | DEACONESS CLINIC, INC |
| Other Organization Name | DEACONESS CLINIC I |
| Practice Address |
3150 Warrick Dr Boonville IN 47601-8602 |
| Mailing Address |
Po Box 1510 Evansville IN 47706-1510 |
| Practice Telephone | 8128583355 |
| Practice Fax Number | 8128583350 |
| Mailing Telephone | 8124506879 |
| Mailing Fax Number | 8128584586 |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | CHERYL A WATHEN (CFO) |
| Authorized Official Telephone | 8124503296 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Deaconess Clinic I | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861961138 | Deaconess Clinic, Inc | Physician Assistant | 350 W Columbia St Ste 440, Evansville, IN 47710-1782 | 2018-11-16 |
| 1225468937 | Deaconess Clinic, Inc | Allergy & Immunology | 4840 S Maple Tree Dr, Princeton, IN 47670-9277 | 2013-11-15 |
| 1396040374 | Deaconess Clinic, Inc | Physician Assistant | 1204 Williams St., Oakland City, IN 47660-1001 | 2011-01-21 |
| 1043466329 | Deaconess Clinic, Inc | Pediatrics | 15814 Neeley St, Evansville, IN 47725-8420 | 2008-08-18 |
| 1306092192 | Deaconess Clinic, Inc | Internal Medicine | 1300 Merritt Dr, Henderson, KY 42420-2788 | 2008-08-12 |
| 1528214400 | Deaconess Clinic, Inc | Psychologist | 685 Vail Street, Princeton, IN 47670-9510 | 2008-08-12 |
| 1407804602 | Deaconess Clinic, Inc | Family Medicine | 10455 Orthopaedic Dr, Newburgh, IN 47630-7955 | 2006-05-04 |
| 1447862958 | Deaconess Clinic, Inc | Nurse Practitioner | 1808 Sherman Dr, Princeton, IN 47670-1043 | 2020-08-18 |
| 1982216495 | Deaconess Clinic, Inc | Nurse Practitioner | 1808 Sherman Dr, Princeton, IN 47670-1043 | 2020-08-18 |
| 1790397206 | Deaconess Clinic, Inc | Nurse Practitioner | 312 3rd Ave, Princeton, IN 47670-1014 | 2020-08-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DEACONESS CLINIC, INC. | 421 Chestnut St, Evansville, IN 47713-1227 |
| Street Address |
3150 WARRICK DR |
| City | BOONVILLE |
| State | IN |
| Zip Code | 47601-8602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053547000 | Linda S Tucker | Nurse Practitioner | 3150 Warrick Dr, Boonville, IN 47601-8602 | 2009-06-04 |
| 1144702945 | Amanda D Strathmann | Nurse Practitioner | 3150 Warrick Dr, Boonville, IN 47601-8602 | 2018-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235617622 | Dante J Grasso | Dentist | 602 W. Locust St., Boonville, IN 47601 | 2018-07-30 |
| 1053785774 | Michael P Royalty Md LLC | Pain Medicine | 4888 Lost Lake Ct, Boonville, IN 47601 | 2015-11-18 |
| 1982097911 | Doctor James E. Eash, D.d.s., P.C. | Exclusive Provider Organization | 911 Aigner Drive, Boonville, IN 47601 | 2015-03-16 |
| 1073734315 | Warrick County School Corp. | Local Education Agency (LEA) | 300 East Gum Street, Boonville, IN 47601 | 2007-05-02 |
| 1811042237 | St. Marys Warrick Hospital, Inc. | Psychiatric Unit | 1116 Millis Avenue, Boonville, IN 47601 | 2007-01-24 |
| 1073687877 | James E Eash | Dentist | 911 Aigner Dr, Boonville, IN 47601 | 2006-11-20 |
| 1902073554 | Tri-state Behavioral Health LLC | Psychiatry & Neurology | 1116 Millis Ave, St. Mary's Warrick, Boonville, IN 47601 | 2008-05-13 |
| 1073668273 | St. Mary's Warrick Hospital, Inc. | Medicare Defined Swing Bed Unit | 1116 Millis Avenue, Boonville, IN 47601 | 2007-01-25 |
| 1790889046 | Jeffrey P Kolb | Dentist | 602 W Locust St, Boonville, IN 47601-0167 | 2006-09-08 |
| 1376631572 | Kolb & Kolb Dds LLC | Dentist | 602 W Locust St, Boonville, IN 47601-0167 | 2006-10-11 |
| Find all providers in zip 47601 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174633622 | Todd M Podkowka | Family Medicine | 6483 Cone Rd, Boonville, NY 13309-3311 | 2006-08-30 |
| 1538181409 | Dancing Horizon Health Foundation, Inc. | Family Medicine | 2400 Boonslick Drive, Boonville, MO 65233 | 2006-07-23 |
| 1235168097 | Sally J Ellebracht-gerke | Family Medicine | 17110 Highway 87, Boonville, MO 65233-2939 | 2006-07-02 |
| 1346293370 | Leyte B Asuncion | Family Medicine | 1115 E Main St, Boonville, IN 47601-2415 | 2006-05-19 |
| 1659331155 | James S. Mooney | Family Medicine | 920 Millis Ave, Boonville, IN 47601-6606 | 2006-03-27 |
| 1568449304 | Anderson Valley Health Center | Family Medicine | 13500 Airport Road, Boonville, CA 95415 | 2005-12-22 |
| 1215918867 | Lori Fuqua | Family Medicine | 3277 Liberty Blvd # A, Boonville, IN 47601-9659 | 2005-11-10 |
| 1427057793 | John Michael Ward | Family Medicine | 306 Main St, Boonville, MO 65233-1566 | 2005-07-19 |
| 1780160366 | Pinnacle Regional Hospital, LLC | Family Medicine | 17651 B Hwy, Boonville, MO 65233-2839 | 2018-07-17 |
| 1225359573 | Aaron Joseph Whiting | Family Medicine | 606 E Spring St, Boonville, MO 65233-1523 | 2010-06-21 |
| Find all providers in BOONVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.