MEDICARE: DEACONESS ILLINOIS CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RI0011X	Interventional Cardiology Physician
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1659097947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS ILLINOIS CLINIC, INC

Provider Business Mailing Address
First Line	:	PO BOX 34156
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0619
Country	:	US
Telephone Number	:	812-450-6815
Fax Number	:	812-450-6822

Provider Business Practice Location Address
First Line	:	1028 S KIRKWOOD RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-7222
Country	:	US
Telephone Number	:	314-287-6184
Fax Number	:	314-394-2253

Authorized Official
Title or Position	:	SECRETARY / TREASURER
Name	:	KYLE DILLMAN
Credential	:
Telephone Number	:	812-450-7399

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	12/02/2022

Similar Medicare Providers

1356415996 — KIRKWOOD AMBULATORY SURGERY CENTER
Practice Location Address:

1028 S KIRKWOOD RD
SAINT LOUIS, MO
63122-7222

Practice Phone: 636-534-2300
Practice Fax:

1386351849 — DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Practice Location Address:

1028 S KIRKWOOD RD
SAINT LOUIS, MO
63122-7222

Practice Phone: 314-287-6184
Practice Fax: 314-394-2253

1306819636 — DR. EDWARD STEVEN WYGONIK O.D.
Practice Location Address:

108 DRUMELLAN CT
SAINT JOHNS, FL
32259-7222

Practice Phone: 412-719-5926
Practice Fax:

1053799007 — ST. LOUIS CARDIOVASCULAR INSTITUTE, LLC
Practice Location Address:

1028 S KIRKWOOD RD
KIRKWOOD, MO
63122-7222

Practice Phone: 314-394-2950
Practice Fax: 314-394-2253

1417335167 — MISSOURI HEART AND VASCULAR INSTITUTE, LLC
Practice Location Address:

1028 S KIRKWOOD RD
KIRKWOOD, MO
63122-7222

Practice Phone: 314-394-2950
Practice Fax: 314-394-2253

1962958389 — ST LOUIS SPECIALTY SURGICAL CENTER LLC
Practice Location Address:

1028 S KIRKWOOD RD
KIRKWOOD, MO
63122-7222

Practice Phone: 314-394-2950
Practice Fax: 314-394-2953

Directions to “DEACONESS ILLINOIS CLINIC, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.