DEACONESS CLINIC, INC
NPI 1174026363
Clinic/Center in Boonville, IN

Active since March 14, 2018CLIA 15D2144696 · Waiver
930 W MAIN ST, BOONVILLE, IN 47601(812) 641-0088(812) 641-0092 Get Directions Write a Review

NPPES record last updated: March 14, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Deaconess Clinic, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEACONESS CLINIC, INC (NPI 1174026363) is a healthcare organization registered as a clinic/center in Boonville, Indiana and active in the NPI registry since March 2018. The organization holds a CLIA Waiver certificate valid through February 20, 2028 and lists Cheryl Annette Wathen, Cfo, as its authorized official.

NPPES Registry Identity

NPI1174026363
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameDEACONESS CLINIC, INC
Location Address930 W MAIN STBoonville, IN 47601-1591
Mailing AddressPo Box 1510Evansville, IN 47706-1510 · (812) 641-0088 · Fax (812) 641-0092
Fax(812) 641-0092
Organization SubpartNo
Authorized OfficialCheryl Annette WathenCfo · (812) 450-3296
Enumeration DateMarch 14, 2018
NPI 1174026363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

930 W MAIN ST, Boonville, IN 47601

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
15D2144696
Facility Type
Physician Office
Certificate Effective Date
February 21, 2026
Certificate Expiration Date
February 20, 2028
Laboratory Director
SCOTT ULOTH
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Deaconess Clinic, Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for DEACONESS CLINIC, INC

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Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Nurse Practitioner
930 W MAIN ST
BOONVILLE, IN 47601

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1174026363, enumerated as an "organization" on March 14, 2018.

The provider is located at 930 W MAIN ST BOONVILLE, IN 47601 and the phone number is (812) 641-0088.

Clinic/Center with taxonomy code 261Q00000X.