Healthcare Provider Details

I. General information

NPI: 1184340408
Provider Name (Legal Business Name): DEACONESS ILLINOIS UNION COUNTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST RM 22
ANNA IL
62906-1668
US

IV. Provider business mailing address

PO BOX 34141
BELFAST ME
04915-0619
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-2295
  • Fax: 618-833-9058
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER LIPE
Title or Position: CFO
Credential:
Phone: 618-998-7020