Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess Illinois Clinic John A Logan
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
700 LOGAN COLLEGE DRIVE, J BUILDING, CARTERVILLE, IL 62918
(618) 926-6698
Mailing address
PO BOX 632330, CINCINNATI, OH 45263-2330
(618) 219-1311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/29/2025
Last updated
05/07/2025
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