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

Deaconess Illinois Specialty Clinic, Inc

Organization Family Medicine Physician · NPI 1003523374

Deaconess Illinois Specialty 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

4117 S Water Tower Pl Ste C
Mount Vernon, IL 62864-6567
Phone: (618) 242-0672
Fax: (618) 242-0862
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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
Otolaryngology Physician Taxonomy 207Y00000X
Audiologist Taxonomy 231H00000X

Record details

NPI number1003523374
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary Treasurer · (812) 450-7399
Other names Deaconess Il Specialty 4117 Water Tower
NPI enumeratedNovember 4, 2022
Last updated in NPPESJanuary 26, 2023
Certification dateJanuary 26, 2023
Mailing addressPo Box 34266, Belfast, ME 04915-0620

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