Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
Deaconess Illinois Specialty Clinic Occupational Health Broadway
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY)
(812) 450-7399
Entity
Organization
Contact information
Practice address
3111 BROADWAY ST, MOUNT VERNON, IL 62864-2338
(618) 241-0333
(618) 241-0334
Mailing address
3111 BROADWAY ST, MOUNT VERNON, IL 62864-2338
(618) 241-0333
(618) 241-0334
Taxonomy
Speciality
Code
Description
License number
State
363LX0106X
Occupational Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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