Healthcare Provider Details

I. General information

NPI: 1619214624
Provider Name (Legal Business Name): NATIONAL HEALTHCARE OF MT VERNON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CROSSROADS PL SUITE 120
MOUNT VERNON IL
62864-6545
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-6222
  • Fax: 618-244-7299
Mailing address:
  • Phone: 800-709-7338
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JAMES WRIGHT
Title or Position: SR DIRECTOR
Credential:
Phone: 615-465-7587