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DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
NPI 1679270763
Nurse Practitioner - Occupational Health in Mount Vernon, IL

Active since February 09, 2023
3111 BROADWAY ST, MOUNT VERNON, IL 62864(618) 241-0333(618) 241-0334 Get Directions Write a Review

NPPES record last updated: February 9, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Deaconess Illinois Specialty Clinic, Inc. NPPES

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

DEACONESS ILLINOIS SPECIALTY CLINIC, INC. (NPI 1679270763), doing business as Deaconess Illinois Specialty Clinic Occupational Health Broadway, is a healthcare organization registered as an occupational health in Mount Vernon, Illinois and active in the NPI registry since February 2023. The organization lists Kyle Dillman, Secretary, as its authorized official.

NPPES Registry Identity

NPI1679270763
Entity TypeOrganization
Primary Taxonomy363LX0106X
Legal Business NameDEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Location Address3111 BROADWAY STMount Vernon, IL 62864-2338
Mailing Address3111 Broadway StMount Vernon, IL 62864-2338 · (618) 241-0333 · Fax (618) 241-0334
Phone(618) 241-0333
Fax(618) 241-0334
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary · (812) 450-7399
Enumeration DateFebruary 9, 2023
NPPES CertifiedFebruary 9, 2023
✔ NPI 1679270763 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Occupational HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LX0106X
3111 BROADWAY ST, Mount Vernon, IL 62864
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Other Names 1

Doing Business AsDeaconess Illinois Specialty Clinic Occupational Health Broadway

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

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

DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Nurse Practitioner
3111 BROADWAY ST
MOUNT VERNON, IL 62864
Jefferson County (618) 241-0300
DEACONESS ILLINOIS CLINIC, INC
Family Medicine
3111 BROADWAY ST
MOUNT VERNON, IL 62864
Jefferson County (618) 241-0300
BRIDGETT NICOLE BROWN FNP-C
Nurse Practitioner
3111 BROADWAY ST
MOUNT VERNON, IL 62864
Jefferson County (618) 241-0333
BRITTANY MCDONALD APRN
Nurse Practitioner
3111 BROADWAY ST
MOUNT VERNON, IL 62864
Jefferson County (618) 241-0300

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 Specialty Clinic, Inc.'s NPI number?

The NPI number for Deaconess Illinois Specialty Clinic, Inc. is 1679270763. It was assigned to this organization in the NPPES registry on February 9, 2023. The provider is doing business as Deaconess Illinois Specialty Clinic Occupational Health Broadway.

Where is Deaconess Illinois Specialty Clinic, Inc. located?

Deaconess Illinois Specialty Clinic, Inc. is located at 3111 Broadway St, Mount Vernon, IL 62864. The listed phone number is (618) 241-0333.

What is Deaconess Illinois Specialty Clinic, Inc.'s specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Occupational Health, with taxonomy code 363LX0106X.

When was this NPI record last updated?

The NPPES record for Deaconess Illinois Specialty Clinic, Inc. was last updated on February 9, 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.