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Deaconess Illinois Specialty Clinic, Inc.

Organization Active NPI Nurse Practitioner · Marion, IL

NPI 1154036259 · NPPES record last updated Jan 26, 2023

Key facts

NPI
1154036259
Entity type
Organization (NPI type 2)
Primary specialty
Nurse Practitioner 363L00000X
Legal business name
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Practice address
3331 W Deyoung St Ste 101
Marion, IL 62959-5896
Phone
(618) 998-7169
Fax
(618) 998-7533
NPI assigned
Jan 23, 2023
Organization subpart
No

Authorized official

Name
Kyle Dillman
Title
Secretary
Phone
(812) 450-7399

Corporate family (same tax ID) 18

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Deaconess Illinois Specialty Clinic Inc (19 organizations share this tax ID)

Locations

3331 W Deyoung St
Ste 101
Marion, IL 62959
Phone (618) 559-0169

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP		 363L00000X Yes
Occupational Health Clinical Nurse Specialist
Group: 193200000X MULTI-SPECIALTY GROUP		 364SX0106X

Addresses

Primary practice location

3331 W Deyoung St Ste 101
Marion, IL 62959-5896

Mailing address

3331 W Deyoung St Ste 101
Marion, IL 62959-5896
Phone (618) 998-7169

Other names

  • Deaconess IL Specialty Clinic Occupational Health Doing business as

Other providers in Marion, IL

All providers in Marion, IL · Nurse Practitioner in Illinois

Sources for this page

Verify at the official NPI Registry.