Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Deaconess Illinois Clinic, Inc

Organization Family Medicine Physician · NPI 1558088138

Deaconess Illinois Clinic, Inc is a Family Medicine Physician in Mount Vernon, Illinois. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
3
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3111 Broadway St
Mount Vernon, IL 62864-2338
Phone: (618) 241-0300
Fax: (618) 241-0302
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1558088138
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary / Treasurer · (812) 450-7399
Other names Deaconess Illinois Clinic; Deaconess Illinois Clinic
NPI enumeratedOctober 24, 2022
Last updated in NPPESDecember 2, 2022
Certification dateDecember 2, 2022
Mailing addressPo Box 34156, Belfast, ME 04915-0619

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