Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
Deaconess IL Specialty Spring St Emergency
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
325 SPRING ST, RED BUD, IL 62278-1105
(618) 282-3831
(618) 282-3550
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/07/2022
Last updated
01/26/2023
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