# DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deaconess IL Specialty 3329 DeYoung
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386351856
- **Authorized official:** KYLE DILLMAN (SECRETARY TREASURER)
- **Authorized official phone:** (812) 450-7399

## Contact information

- **Practice address:** 3329 W DEYOUNG ST, MARION, IL 62959-5884
- **Practice address phone:** (618) 998-7177
- **Practice address fax:** (618) 998-7175
- **Mailing address:** PO BOX 34266, BELFAST, ME 04915-0620
- **Mailing address phone:** (812) 450-6815
- **Mailing address fax:** (812) 450-6822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/03/2022
- **Last updated:** 01/26/2023