Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
St. Louis Cardiovascular, Deaconess IL Specialty Spring St Multispecialty
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
350 W SOUTH 1ST ST, RED BUD, IL 62278-1116
(618) 282-7373
(618) 282-7376
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/03/2022
Last updated
06/29/2023
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