NPI 1003523374 · live from the CMS NPI Registry
Deaconess Illinois Specialty Clinic, INC.
Family Medicine in Mount Vernon, IL. National Provider Identifier 1003523374, active.
NPI record
| NPI | 1003523374 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 4117 S Water Tower Pl Ste C, Mount Vernon, IL 62864 |
| Practice phone | 618-242-0672 |
| Mailing address | Po Box 34266, Belfast, ME 04915 |
| Enumerated | November 4, 2022 |
| Last updated | January 26, 2023 |
| Authorized official | Kyle Dillman, Secretary Treasurer |
| Other names | Deaconess Il Specialty 4117 Water Tower |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Otolaryngology | 207Y00000X | — |
| Audiologist | 231H00000X | — |
| Family Medicine primary | 207Q00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.