Deaconess Illinois Clinic, Inc
Organization Active NPI Family Medicine Physician · Sparta, IL
NPI 1225754526 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1225754526
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS ILLINOIS CLINIC, INC
- Practice address
- 205 S Burns Ave
Sparta, IL 62286-1867 - Phone
- (618) 443-2858
- Fax
- (618) 939-4256
- 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 | ||
| Interventional Cardiology Physician |
207RI0011X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
205 S Burns Ave
Sparta, IL 62286-1867
Mailing address
PO Box 34156
Belfast, ME 04915-0619
Phone (812) 450-6815
Other names
- Deaconess Illinois Clinic
Other providers in Sparta, IL
- Comwell
- Russell Coulter
- County of Randolph Nursing Home
- Kermit Cox
- Nancy Ann Davison
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Alisa D Dearmond
- Andra Marie Dehn
All providers in Sparta, 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.