Deaconess Illinois Clinic, INC

NPI #1962128256 in Columbia, Illinois

Provider Information

NPI Number: 1962128256
Entity Type: Organization
Organization Name: Deaconess Illinois Clinic, INC
Primary Specialty: Family Medicine
Enumeration Date: Oct 18, 2022
Last Updated: Jan 26, 2023

Practice Location

Address: 1000 ELEVEN S STE 2E
City: Columbia
State: Illinois
ZIP Code: 62236-1079
Phone: (618) 281-2773

Authorized Official

Name: KYLE DILLMAN
Title: SECRETARY / TREASURER
Phone: (812) 450-7399

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Family Medicine	207Q00000X	Primary

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