Healthcare Provider Details

I. General information

NPI: 1528305448
Provider Name (Legal Business Name): NATIONAL HEALTHCARE OF MT VERNON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W ROBINSON ST
WAYNE CITY IL
62895-9672
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 618-895-2050
  • Fax: 618-895-2056
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

VIII. Authorized Official

Name: SOPHIA ARWOOD
Title or Position: DIRECTOR
Credential:
Phone: 615-628-6038