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1578417705 NPI number — DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

NPI Number: 1578417705
Health Care Provider/Practitioner: DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

Information about “1578417705” NPI (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.) exists in 1578417705 in HTML format HTML  |  1578417705 in plain Text format TXT  |  1578417705 in PDF (Portable Document Format) PDF  |  1578417705 in an XML format XML  formats.

NPI Number : 1578417705 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578417705",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DEACONESS ILLINOIS SPECIALTY CLINIC, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "205 BAILEY LN STE F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTON",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62812-1921",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-918-0645",
    "MailingAddressFaxNumber": "618-918-6046",
    "FirstLinePracticeLocationAddress": "205 BAILEY LN STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BENTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62812-1921",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-918-0645",
    "PracticeLocationAddressFaxNumber": "618-918-6046",
    "EnumerationDate": "02/24/2026",
    "LastUpdateDate": "02/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DILLMAN",
    "AuthorizedOfficialFirstName": "KYLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "SECRETARY",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "812-450-7399",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR1300X",
        "TaxonomyName": "Rural Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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