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

Deaconess Illinois Specialty Clinic, Inc

Organization Sports Medicine (Family Medicine) Physician · NPI 1477260743

Deaconess Illinois Specialty Clinic, Inc is a Sports Medicine (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

4113 S Water Tower Pl
Mount Vernon, IL 62864-6293
Phone: (618) 241-9071
Fax: (618) 241-9079
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1477260743
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary Treasurer · (812) 450-7399
Other names Deaconess Il Specialty 4113 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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