Healthcare Provider Details

I. General information

NPI: 1750353041
Provider Name (Legal Business Name): NATIONAL HEALTHCARE OF MT VERNON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DOCTORS PARK RD
MOUNT VERNON IL
62864-6224
US

IV. Provider business mailing address

PO BOX 60548
SAINT LOUIS MO
63160-0548
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-5500
  • Fax: 618-244-5566
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0003947
License Number StateIL

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OPERATIONS/AO
Credential:
Phone: 615-221-3840