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Contact Information

DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
205 BAILEY LN STE F
BENTON, IL62812-1921
 Phone: 618-882-4200
 Fax: 618-882-4208
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

NPI Number 1629785183
LBN Legal business name DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Authorized official KYLE DILLMAN - (SECRETARY TREASURER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/03/2022
Last updated 01/26/2023 - About 3 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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