- Practice location
- 205 S Burns Ave, Sparta, IL 62286-1867
- Phone
- 618-443-2858
- Fax
- 618-939-4256
- Last updated
- January 26, 2023
Deaconess Illinois Specialty Clinic, INC. is a healthcare organization based in Sparta, IL. Deaconess Illinois Specialty Clinic, INC. practices in Sparta, IL. The NPI Number for Deaconess Illinois Specialty Clinic, INC. is 1619684172. The current practice location address for Deaconess Illinois Specialty Clinic, INC. is 205 S Burns Ave, Sparta, IL 62286-1867 and can be reached out via phone at 618-443-2858 and via fax at 618-939-4256.
Provider Profile Details
- NPI Number
- 1619684172
- Provider Name
- Deaconess Illinois Specialty Clinic, INC.
- Provider Entity Type
- Organization
- Address
- 205 S Burns Ave, Sparta, IL 62286-1867
- Phone Number
- 618-443-2858
- Fax Number
- 618-939-4256
- Primary Taxonomy
- Internal Medicine, Interventional Cardiology · 207RI0011X
- Organization Subpart
- No
- Authorized Official
- Kyle Dillman · Secretary Treasurer · 812-450-7399
- Other Names
- St. Louis Cardiovascular (Doing Business As)
Deaconess Il Specialty Burns Ave (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
- 205 S Burns Ave
Sparta, IL 62286-1867 - City
- Sparta
- State
- Illinois
- Zip
- 62286-1867
- Phone Number
- 618-443-2858
- Fax Number
- 618-939-4256
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)
- Physician Assistant · 363A00000X
- Taxonomy (2)
- Physician Assistant, Medical · 363AM0700X
- Taxonomy (3)
- Nurse Practitioner · 363L00000X
- Taxonomy (4)
- Internal Medicine, Interventional Cardiology · 207RI0011X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Internal Medicine, Interventional Cardiology providers near Sparta, IL
View all Internal Medicine, Interventional Cardiology providers in Sparta →Frequently Asked Questions
What is the NPI number of Deaconess Illinois Specialty Clinic, INC.?
The NPI number of Deaconess Illinois Specialty Clinic, INC. is 1619684172. 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 Internal Medicine, Interventional Cardiology (code 207RI0011X).
Where does Deaconess Illinois Specialty Clinic, INC. practice?
The practice location is 205 S Burns Ave, Sparta, IL 62286-1867. The office can be reached at 618-443-2858 (phone) or 618-939-4256 (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 1619684172 directly on the NPPES registry website.