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

Deaconess Illinois Specialty Clinic, Inc

Organization Interventional Cardiology Physician · NPI 1619684172

Deaconess Illinois Specialty Clinic, Inc is an Interventional Cardiology Physician in Sparta, Illinois. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
4
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

205 S Burns Ave
Sparta, IL 62286-1867
Phone: (618) 443-2858
Fax: (618) 939-4256
Show map & directions

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

Specialties & licences

Interventional Cardiology Physician (primary) Taxonomy 207RI0011X
Physician Assistant Taxonomy 363A00000X
Medical Physician Assistant Taxonomy 363AM0700X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1619684172
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary Treasurer · (812) 450-7399
Other names Deaconess Il Specialty Burns Ave; St. Louis Cardiovascular
NPI enumeratedNovember 3, 2022
Last updated in NPPESJanuary 26, 2023
Certification dateJanuary 26, 2023
Mailing addressPo Box 34266, Belfast, ME 04915-0620

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