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Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
River to River Heart Group, Deaconess IL Specialty Crossroads Pl
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
209 CROSSROADS PL, MOUNT VERNON, IL 62864-6545
(618) 244-1937
(618) 241-9079
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/04/2022
Last updated
01/26/2023
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