# DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1730896291
- **Authorized official:** KYLE DILLMAN (SECRETARY TREASURER)
- **Authorized official phone:** (812) 450-7399

## Contact information

- **Practice address:** 1201 RICKER RD, SALEM, IL 62881-4263
- **Practice address phone:** (182) 418-7916
- **Practice address fax:** (618) 244-1926
- **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 |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

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