Deaconess Illinois Specialty Clinic, Inc
Deaconess Illinois Specialty Clinic, Inc provides Sports Medicine (Family Medicine) Physician services in Mount Vernon, Illinois. Registered with an NPI since 2022.
- In the registry since
- 2022
- Specialties on file
- 2
What do these letters mean?
- Inc — Incorporated
- A form of business registration, not a clinical qualification.
Practice location Address checks out
3111 Broadway StMount Vernon, IL 62864-2338
Phone: (618) 241-0300
Fax: (618) 241-0302
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Nurse Practitioner (primary) | Taxonomy 363L00000X |
|---|---|
| Sports Medicine (Family Medicine) Physician | Taxonomy 207QS0010X |
Record details
| NPI number | 1497462964 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Kyle Dillman — Secretary Treasurer · (812) 450-7399 |
| Other names | Deaconess Il Specialty Express Broadway St |
| NPI enumerated | November 3, 2022 |
| Last updated in NPPES | January 26, 2023 |
| Certification date | January 26, 2023 |
| Mailing address | Po Box 34266, Belfast, ME 04915-0620 |
Other providers in Mount Vernon
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Deaconess Illinois Specialty Clinic, Inc
4113 S Water Tower Pl, Mount Vernon, IL 62864-6293 · (618) 241-9071