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General NPI Number Information
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NPI Number | 1619602604
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Entity Type | Organization
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Legal Business Name | NATIONAL HEALTHCARE OF MT VERNON INC
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 205 BAILEY LN STE F
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City | BENTON
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State | IL
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Zip | 62812-1921
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Country | US
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Telephone | 618-882-4200
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Fax | 618-882-4208
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Provider Business Mailing Address
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Address Line | PO BOX 5009
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City | BRENTWOOD
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State | TN
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Zip | 37024-5009
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Country | US
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Telephone | 615-221-3722
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Fax |
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Authorized Official
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Title or Position | SVP FINANCE OP
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Name | RANDY MICHAEL COOPER
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Credential |
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Telephone | 615-221-3840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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