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DEACONESS ILLINOIS CLINIC
NPI 1407572860
Surgery in Marion, IL

Active since October 18, 2022CLIA 14D1021062 · Waiver
3331 W DEYOUNG ST, MARION, IL 62959(618) 998-7600(618) 997-6680 Get Directions Write a Review

NPPES record last updated: December 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 2, 2022, Oct 18, 2022 (2 updates tracked since 2022).

About Deaconess Illinois Clinic NPPES

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

DEACONESS ILLINOIS CLINIC (NPI 1407572860) is a healthcare organization registered as a surgery in Marion, Illinois and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through January 11, 2028 and lists Kyle Dillman, Secretary / Treasurer, as its authorized official.

NPPES Registry Identity

NPI1407572860
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NameDEACONESS ILLINOIS CLINIC, INC
Location Address3331 W DEYOUNG STMarion, IL 62959-5896
Mailing AddressPo Box 34156Belfast, ME 04915-0619 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 998-7600
Fax(618) 997-6680
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary / Treasurer · (812) 450-7399
Enumeration DateOctober 18, 2022
Last NPPES UpdateDecember 2, 20222 updates tracked since enumeration
NPPES CertifiedDecember 2, 2022
✔ NPI 1407572860 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 14

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · Clinical Cardiac ElectrophysiologyTaxonomy 207RC0001X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedInternal Medicine · Hematology & OncologyTaxonomy 207RH0003X
Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X
Also ListedSurgery · Vascular SurgeryTaxonomy 2086S0129X
Also ListedUrologyTaxonomy 208800000X
Also ListedColon & Rectal SurgeryTaxonomy 208C00000X
Also ListedPodiatristTaxonomy 213E00000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
3331 W DEYOUNG ST, Marion, IL 62959
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Other Names 1

Doing Business AsDeaconess Illinois Clinic

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 14D1021062

Deaconess Illinois Specialty Clinic · Marion, IL
Active · expires Jan 11, 2028
CLIA Number14D1021062
Laboratory TypePhysician Office
Certificate Effective DateJanuary 12, 2026
Certificate Expiration DateJanuary 11, 2028
Laboratory DirectorVictor Mwansa
Laboratory Phone(618) 998-7600
Laboratory LocationDeaconess Illinois Specialty Clinic3331 W De Young, Ste 100, Marion, IL 62959
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

SOUTHERN ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Family Medicine
3331 W DEYOUNG ST, SUITE 305
MARION, IL 62959
Williamson County (618) 998-7000
DR. PARAG ARVIND MADHANI MD
Internal Medicine (Cardiovascular Disease)
3331 W DEYOUNG ST, SUITE 100
MARION, IL 62959
Williamson County (618) 998-7600
ALLAN C GOCIO MD NEUROSURGICAL CARE, LLC
Neurological Surgery
3331 W DEYOUNG ST, STE 308
MARION, IL 62959
Williamson County (618) 997-1200
HEARTLAND RURAL HEALTHCARE, LLC
Family Medicine
3331 W DEYOUNG ST
MARION, IL 62959
Williamson County (618) 998-7000
ALI SALIMI MD
Internal Medicine (Interventional Cardiology)
3331 W DEYOUNG ST, STE 308
MARION, IL 62959
Williamson County (618) 998-0052
HEARTLAND RURAL HEALTHCARE, LLC
Family Medicine
3331 W DEYOUNG ST, SUITE 207
MARION, IL 62959
Williamson County (618) 985-9140
RIVER TO RIVER HEART GROUP, LLC
Internal Medicine
3331 W DEYOUNG ST, SUITE 203
MARION, IL 62959
Williamson County (618) 997-4733
SHERRI K PARR PA-C
Physician Assistant
3331 W DEYOUNG ST, SUITE 201
MARION, IL 62959
Williamson County (618) 998-9888

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 1407572860. It was assigned to this organization in the NPPES registry on October 18, 2022. The provider is doing business as Deaconess Illinois Clinic.

Where is Deaconess Illinois Clinic, Inc located?

Deaconess Illinois Clinic, Inc is located at 3331 W Deyoung St, Marion, IL 62959. The listed phone number is (618) 998-7600.

What is Deaconess Illinois Clinic, Inc's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

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

Yes. A Certificate of Waiver (number 14D1021062) is associated with this NPI, valid through January 11, 2028. 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 December 2, 2022. 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.