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NPI Code Detail

MEDICARE: NATIONAL HEALTHCARE OF MT VERNON INC

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
1275N00000XMedicare Defined Swing Bed Hospital Unit0003947IL

General Provider Information

NPI Number : 1851363154
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATIONAL HEALTHCARE OF MT VERNON INC
Provider Business Mailing Address
First Line : PO BOX 60548
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63160-0548
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8 DOCTORS PARK RD
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6224
Country : US
Telephone Number : 618-244-5500
Fax Number : 618-244-5566
Authorized Official
Title or Position : SVP FINANCE OP/AUTHORIZED OFFICIAL
Name : RANDY MICHAEL COOPER
Credential :
Telephone Number : 615-221-3840
Provider Enumeration Date : 02/02/2006
Last Update Date : 08/11/2020

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Directions to “NATIONAL HEALTHCARE OF MT VERNON INC ” Practice Location

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