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Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess Illinois Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY / TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
3111 BROADWAY ST, MOUNT VERNON, IL 62864-2338
(618) 241-0300
(618) 241-0302
Mailing address
PO BOX 34156, BELFAST, ME 04915-0619
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/24/2022
Last updated
12/02/2022
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