OrganizationActive
Deaconess Illinois Specialty Clinic, Inc.
NPI 1619684172 · Interventional Cardiology Physician · Sparta, IL
Provider details
- NPI number
- 1619684172
- Entity type
- Organization
- Primary specialty
- Interventional Cardiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kyle Dillman, Secretary Treasurer(812) 450-7399
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
- Medical Physician Assistant363AM0700X
Physician Assistants & Advanced Practice Nursing Providers
- Nurse Practitioner363L00000X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
205 S Burns Ave
Sparta, IL 62286-1867
Phone: (618) 443-2858
Fax: (618) 939-4256
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 34266
Belfast, ME 04915-0620
Other names (DBA / former)
- Doing business as
- Deaconess Il Specialty Burns Ave
- Doing business as
- St. Louis Cardiovascular
Registry dates
- Enumerated
- 2022-11-03
- Last updated
- 2023-01-26
- Certified
- 2023-01-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.