Deaconess Illinois Specialty Clinic, INC.
Nurse Practitioner in Mount Vernon, Illinois
1497462964- Practice location
- 3111 Broadway St, Mount Vernon, IL 62864-2338
- Phone
- 618-241-0300
- Fax
- 618-241-0302
- Last updated
- January 26, 2023
Deaconess Illinois Specialty Clinic, INC. is a healthcare organization based in Mount Vernon, IL. Deaconess Illinois Specialty Clinic, INC. practices in Mount Vernon, IL. The NPI Number for Deaconess Illinois Specialty Clinic, INC. is 1497462964. The current practice location address for Deaconess Illinois Specialty Clinic, INC. is 3111 Broadway St, Mount Vernon, IL 62864-2338 and can be reached out via phone at 618-241-0300 and via fax at 618-241-0302.
Provider Profile Details
- NPI Number
- 1497462964
- Provider Name
- Deaconess Illinois Specialty Clinic, INC.
- Provider Entity Type
- Organization
- Address
- 3111 Broadway St, Mount Vernon, IL 62864-2338
- Phone Number
- 618-241-0300
- Fax Number
- 618-241-0302
- Primary Taxonomy
- Nurse Practitioner · 363L00000X
- Organization Subpart
- No
- Authorized Official
- Kyle Dillman · Secretary Treasurer · 812-450-7399
- Other Names
- Deaconess Il Specialty Express Broadway St (Doing Business As)
- Provider Enumeration Date
- November 3, 2022
- Last Update Date
- January 26, 2023
- Certification Date
- January 26, 2023
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 3111 Broadway St
Mount Vernon, IL 62864-2338 - City
- Mount Vernon
- State
- Illinois
- Zip
- 62864-2338
- Phone Number
- 618-241-0300
- Fax Number
- 618-241-0302
Provider Business Mailing Address Details
- Address
- Po Box 34266
Belfast, ME 04915-0620 - City
- Belfast
- State
- ME
- Zip
- 04915-0620
- Phone Number
- 812-450-6815
- Fax Number
- 812-450-6822
License Information
- Taxonomy (1)
- Family Medicine, Sports Medicine · 207QS0010X
- Taxonomy (2)
- Nurse Practitioner · 363L00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Deaconess Illinois Specialty Clinic, INC.?
The NPI number of Deaconess Illinois Specialty Clinic, INC. is 1497462964. It was assigned on November 3, 2022 and is currently active in the NPPES registry.
What is the specialty of Deaconess Illinois Specialty Clinic, INC.?
Deaconess Illinois Specialty Clinic, INC. is registered under the primary taxonomy Nurse Practitioner (code 363L00000X).
Where does Deaconess Illinois Specialty Clinic, INC. practice?
The practice location is 3111 Broadway St, Mount Vernon, IL 62864-2338. The office can be reached at 618-241-0300 (phone) or 618-241-0302 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1497462964 directly on the NPPES registry website.