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Contact Information

DEACONESS ILLINOIS CLINIC, INC
1201 RICKER RD
SALEM, IL62881-4263
 Phone: 618-241-8791
 Fax: 618-244-1926
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for DEACONESS ILLINOIS CLINIC, INC

NPI Number 1003532391
LBN Legal business name DEACONESS ILLINOIS CLINIC, INC
Authorized official KYLE DILLMAN - (SECRETARY / TREASURER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/18/2022
Last updated 12/02/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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