Basic Information
| Provider Information | |||||||||
| NPI: | 1962753277 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATIONAL HEALTHCARE OF MT VERNON INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CROSSROADS FAMILY MEDICINE OF MT VERNON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007097338 | ||||||||
| FaxNumber: | 6154696505 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 CROSSROADS PL | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628646545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182446222 | ||||||||
| FaxNumber: | 6182447299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICAL | ||||||||
| AuthorizedOfficialTelephone: | 6152213672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 0003947 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.