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DEACONESS IL CLINIC 17TH ST
NPI 1326765090
Family Medicine in Marion, IL

Active since October 24, 2022CLIA 14D1090373 · Waiver
2703 17TH ST APT D, MARION, IL 62959(618) 998-9200(618) 998-9700 Get Directions Write a Review

NPPES record last updated: February 2, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 2, 2023, Jan 26, 2023, Dec 2, 2022 and 1 more (4 updates tracked since 2022).

About Deaconess Il Clinic 17th St NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEACONESS IL CLINIC 17TH ST (NPI 1326765090) is a healthcare organization registered as a family medicine in Marion, Illinois and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through October 8, 2026 and lists Kyle Dillman, Secretary / Treasurer, as its authorized official.

NPPES Registry Identity

NPI1326765090
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDEACONESS ILLINOIS CLINIC, INC
Location Address2703 17TH ST APT DMarion, IL 62959-4912
Mailing AddressPo Box 34156Belfast, ME 04915-0619 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 998-9200
Fax(618) 998-9700
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary / Treasurer · (812) 450-7399
Enumeration DateOctober 24, 2022
Last NPPES UpdateFebruary 2, 20234 updates tracked since enumeration
NPPES CertifiedFebruary 2, 2023
✔ NPI 1326765090 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedNurse PractitionerTaxonomy 363L00000X
2703 17TH ST APT D, Marion, IL 62959
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Other Names 1

Doing Business AsDeaconess Il Clinic 17th St

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1090373

Deaconess Illinois Clinic · Marion, IL
Active · expires Oct 8, 2026
CLIA Number14D1090373
Laboratory TypePhysician Office
Certificate Effective DateOctober 9, 2024
Certificate Expiration DateOctober 8, 2026
Laboratory DirectorEric Graham
Laboratory Phone(618) 998-9200
Laboratory LocationDeaconess Illinois Clinic2703 17th St - Ste D, Marion, IL 62959
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERIC SEAN GRAHAM MD
Family Medicine
2703 17TH ST APT D
MARION, IL 62959
Williamson County (618) 998-9200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Deaconess Illinois Clinic, Inc's NPI number?

The NPI number for Deaconess Illinois Clinic, Inc is 1326765090. It was assigned to this organization in the NPPES registry on October 24, 2022. The provider is doing business as Deaconess Il Clinic 17th St.

Where is Deaconess Illinois Clinic, Inc located?

Deaconess Illinois Clinic, Inc is located at 2703 17th St Apt D, Marion, IL 62959. The listed phone number is (618) 998-9200.

What is Deaconess Illinois Clinic, Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Deaconess Illinois Clinic, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1090373) is associated with this NPI, valid through October 8, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Deaconess Illinois Clinic, Inc was last updated on February 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.