MEDICARE: NATIONAL HEALTHCARE OF MT VERNON INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	0003947	IL

General Provider Information

NPI Number	:	1932450772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL HEALTHCARE OF MT VERNON INC

Provider Business Mailing Address
First Line	:	1573 MALLORY LN STE 100
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2895
Country	:	US
Telephone Number	:	152-221-1400
Fax Number	:	615-469-6505

Provider Business Practice Location Address
First Line	:	1209 W ROBINSON ST
Second Line	:
City	:	WAYNE CITY
State	:	IL
Zip	:	62895-9672
Country	:	US
Telephone Number	:	618-895-2050
Fax Number	:	618-895-2056

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	07/07/2023

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