Deaconess Illinois Specialty Clinic, Inc.
Organization Active NPI Family Medicine Physician · West Frankfort, IL
NPI 1447965751 · NPPES record last updated Jan 20, 2023
Key facts
- NPI
- 1447965751
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
- Practice address
- 909 W Main St Ste 2
West Frankfort, IL 62896-2209 - Phone
- (812) 450-6815
- Fax
- (812) 450-6822
- NPI assigned
- Jan 20, 2023
- Organization subpart
- No
Authorized official
- Name
- Kyle Dillman
- Title
- Secretary
- Phone
- (812) 450-7399
Other NPIs on the same Medicare enrollment 23
Practitioners 11
-
Andrew Michael Britt, D.O
-
Theresa McFadin, FNP-C
-
Rachel Marie Rushing, APRN
-
David Shiyu Zhu, MD
-
Paul C Adjei, M.D.
-
Chad R Reid, M.D.
-
Darla M Talbott, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230321001688 | IL | Part B Supplier - Clinic/Group Practice | 9830562016 |
Receives reassigned benefits from 243 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marion, IL; West Frankfort, IL; Waterloo, IL; Salem, IL; Red Bud, IL; Mount Vernon, IL; Benton, IL; Harrisburg, IL… |
National Provider Directory
Locations
909 W Main St
Ste 2
West Frankfort, IL 62896
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | |||
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
909 W Main St Ste 2
West Frankfort, IL 62896-2209
Mailing address
PO Box 34266
Belfast, ME 04915-0620
Phone (812) 450-6815
Other names
- Deaconess IL Specialty Express 909 W Main St
Other providers in West Frankfort, IL
- Jessica Dansberry
- Kimberly M Darnstaedt
- Bonnie Davis
- Marthalina Davis
- Darla Dawson
- Deaconess Illinois Specialty Clinic, Inc.
- Tamara Delong
- Amanda Denney
- Kelsie Deppen
- Jonathan David Diaz
All providers in West Frankfort, 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 Jan 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.