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Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
Deaconess IL Specialty Bailey Ln
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
205 BAILEY LN STE F, BENTON, IL 62812-1921
(618) 882-4200
(618) 882-4208
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/03/2022
Last updated
01/26/2023
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