MEDICARE: ALS MOUNT VERNON INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QH0700X	Hearing and Speech Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center
3	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2630N	OTHER	OH	LICENSURE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053987446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALS MOUNT VERNON INC

Provider Business Mailing Address
First Line	:	26261 MAIN ST
Second Line	:
City	:	COOLVILLE
State	:	OH
Zip	:	45723-9204
Country	:	US
Telephone Number	:	740-350-9095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 GAMBIER RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3839
Country	:	US
Telephone Number	:	740-415-1138
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	JEFF DEGYANSKY
Credential	:
Telephone Number	:	330-620-7828

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	07/05/2023

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Directions to “ALS MOUNT VERNON INC ” Practice Location

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