Healthcare Provider Details

I. General information

NPI: 1790690022
Provider Name (Legal Business Name): DEACONESS ILLINOIS SURGERY CENTER MARION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CIVIC CIRCLE BLVD
MARION IL
62959-5259
US

IV. Provider business mailing address

PO BOX 631947
CINCINNATI OH
45263-1947
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-1112
  • Fax: 618-993-1113
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON HINKLE
Title or Position: CFO
Credential:
Phone: 865-599-4770