DEACONESS ILLINOIS CLINIC INC NPI 1770209082

NPI Information

  • NPI: 1770209082
  • Provider Name: DEACONESS ILLINOIS CLINIC, INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: DEACONESS ILLINOIS CLINIC
  • Address: 325 SPRING ST
    RED BUD, IL
    ZIP 62278
  • Phone: (618) 939-2273

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NPI Details

DEACONESS ILLINOIS CLINIC, INC is a family medicine in Red Bud, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DEACONESS ILLINOIS CLINIC, INC NPI is 1770209082. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Deaconess Illinois Clinic.

The provider's business location address is:

325 SPRING ST
RED BUD, IL
ZIP 62278-105
Phone: (618) 939-2273
Fax: (618) 939-0245

The provider's authorized official is Kyle Dillman .
The authorized official title is Secretary / Treasurer and has the following contact phone number (812) 450-7399.

The enumeration date for this NPI number is 10/18/2022 and was last updated on 12/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RI0011XInternal MedicineInterventional CardiologyNo
2208600000XSurgeryNo
3208800000XUrologyNo
4208VP0000XPain MedicinePain MedicineNo
5363A00000XPhysician AssistantNo
6363L00000XNurse PractitionerNo
7207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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