Basic Information
| Provider Information | |||||||||
| NPI: | 1619602604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL HEALTHCARE OF MT VERNON INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5009 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370245009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152213722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 BAILEY LN STE F | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628121921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188824200 | ||||||||
| FaxNumber: | 6188824208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP FINANCE OP | ||||||||
| AuthorizedOfficialTelephone: | 6152213840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.