DEACONESS IL SPECIALTY BROADWAY ST – NPI #1073220349
Internal Medicine

An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.

DEACONESS IL SPECIALTY BROADWAY ST is a provider located in SPARTA, IL. NPPES has assigned the NPI number 1073220349 to DEACONESS IL SPECIALTY BROADWAY ST on November 04, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “DEACONESS IL SPECIALTY BROADWAY ST” is a dba name, the actual legal business name for this organization is DEACONESS ILLINOIS SPECIALTY CLINIC, INC.. This provider is also associated with 2 additional names listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RI0011X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Interventional Cardiology

The NPI profile was previously updated about 3 years ago on Jan 26, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DEACONESS IL SPECIALTY BROADWAY ST below.

NPI Profile for
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.

NPI Number
1073220349
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Doing Business As (dba): DEACONESS IL SPECIALTY BROADWAY ST
Other name(s)
All associated names:
Doing Business As (dba)
DEACONESS IL SPECIALTY BROADWAY ST
Doing Business As (dba)
St. Louis Cardiovascular
Primary location
818 E BROADWAY ST
SPARTA, IL 62286-1820
Phone: (618) 939-4200 Fax: (618) 939-4256
Mailing address
PO BOX 34266
BELFAST, ME 04915-0620
Phone: (812) 450-6815 Fax: (812) 450-6822
Organization Subpart
No
Authorized Official
KYLE DILLMAN
SECRETARY TREASURER
Phone: (812) 450-7399
Updated
Certification Date
Jan 26, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RI0011X
- Internal Medicine / Interventional Cardiology (Primary)
363A00000X
- Physician Assistant

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.