Deaconess Il Specialty Express Broadway St

LBN: Deaconess Illinois Specialty Clinic, Inc.
Deaconess Il Specialty Express Broadway St is an health care organization with primary practice located at 3111 Broadway St , Mount Vernon IL 62864-2338. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is the primary health care specialty. Deaconess Illinois Specialty Clinic, Inc. can be contacted via phone (618) 241-0300, or through Dillman, Kyle via phone (812) 450-7399.

Contact Information

Primary practice address
3111 Broadway St Mount Vernon IL 62864-2338
Phone: (618) 241-0300
Fax: (618) 241-0302
Website:
Map and Directions
Authorized official contact:
Name: Dillman, Kyle
Phone: (812) 450-7399

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1497462964
LBN Legal business name Deaconess Illinois Specialty Clinic, Inc.
DBA Doing business as Deaconess Il Specialty Express Broadway St
Authorized official Dillman, Kyle
Entity Organization
Organization subpart 1 No
Enumeration date Nov 3rd, 2022
Last updated Jan 26th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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