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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1528305448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL HEALTHCARE OF MT VERNON INC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	800-709-7338
Fax Number	:	615-465-3007

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	:	DIRECTOR
Name	:	SOPHIA ARWOOD
Credential	:
Telephone Number	:	615-628-6038

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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