Provider Demographics
NPI:1447455654
Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIAN
Entity type:Organization
Organization Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-842-4200
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3239
Mailing Address - Country:US
Mailing Address - Phone:812-842-4530
Mailing Address - Fax:812-842-4535
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:SUITE 2900
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-842-4530
Practice Address - Fax:812-842-4535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01022970OtherSTATE LICENSE NO.
INBB1002980OtherDEA-FEDERAL
INBB1002980OtherDEA-FEDERAL