Deaconess Illinois Clinic, Inc
Organization Active NPI Family Medicine Physician · Mount Vernon, IL
NPI 1558088138 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1558088138
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS ILLINOIS CLINIC, INC
- Practice address
- 3111 Broadway St
Mount Vernon, IL 62864-2338 - Phone
- (618) 241-0300
- Fax
- (618) 241-0302
- NPI assigned
- Oct 24, 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 | ||
| Sports Medicine (Family Medicine) Physician |
207QS0010X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
3111 Broadway St
Mount Vernon, IL 62864-2338
Mailing address
PO Box 34156
Belfast, ME 04915-0619
Phone (812) 450-6815
Other names
- Deaconess Illinois Clinic
Other providers in Mount Vernon, IL
- Jason A Davison
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Crossroads Inc
- Deaconess Illinois Crossroads Inc
- Deaconess Illinois Crossroads Inc
- Deaconess Illinois Specialty Clinic, Inc.
All providers in Mount Vernon, 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.