Deaconess Illinois Clinic, Inc
Organization Active NPI Family Medicine Physician · Salem, IL
NPI 1003532391 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1003532391
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS ILLINOIS CLINIC, INC
- Practice address
- 1201 Ricker Rd
Salem, IL 62881-4263 - Phone
- (618) 241-8791
- Fax
- (618) 244-1926
- NPI assigned
- Oct 18, 2022
- Organization subpart
- No
Authorized official
- Name
- Kyle Dillman
- Title
- Secretary / Treasurer
- Phone
- (812) 450-7399
Corporate family (same tax ID) 20
National Provider Directory
- Tax ID family
- Deaconess Illinois Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Physician Assistant |
363A00000X |
Addresses
Primary practice location
1201 Ricker Rd
Salem, IL 62881-4263
Mailing address
PO Box 34156
Belfast, ME 04915-0619
Phone (812) 450-6815
Other names
- Deaconess Illinois Clinic
Other providers in Salem, IL
- County of Marion
- County of Marion
- Crossroads Physician Corp
- Samuel Dalagan
- Alexis Kate De Jager
- Deaconess Illinois Specialty Clinic, Inc.
- Amethyst Deneal
- Doctors Nursing & Rehab Center
- Doris Ann Osborne Els OD
- Anton John Dubrick
All providers in Salem, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.