PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY (NPI# 1649283870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649283870 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY |
| Practice Address |
3307 Broadway St Ste 130 Mount Vernon IL 62864-2347 |
| Practice Telephone | 6182442560 |
| Practice Fax Number | 6182441572 |
| Mailing Telephone | 6182442560 |
| Mailing Fax Number | 6182441572 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2008-10-15 |
| Authorized Official Name | VEENA K GUPTA (CEO) |
| Authorized Official Telephone | 6182447200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Street Address |
3307 BROADWAY ST STE 130 |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790713899 | Veena Kawatra Gupta | Family Medicine | 3307 Broadway St, Ste 140, Mount Vernon, IL 62864-2347 | 2006-06-28 |
| 1033491444 | Lormed LLC | Durable Medical Equipment & Medical Supplies | 3307 Broadway St, Suite 150, Mount Vernon, IL 62864-2387 | 2011-09-12 |
| 1285850396 | Brad Mcmillin, Inc | Hearing Aid Equipment | 3307 Broadway St, Suite 160, Mount Vernon, IL 62864-2347 | 2007-04-17 |
| 1346376274 | James Edward Keeler | Physician Assistant | 3307 Broadway St, Suite 140, Mount Vernon, IL 62864-2347 | 2007-02-26 |
| 1508917543 | Kenneth C Smith | Physical Therapist | 3307 Broadway St, Suite 140, Mount Vernon, IL 62864-2347 | 2007-01-16 |
| 1598777435 | Care First Medical Center | Family Medicine | 3307 Broadway St, Ste 140, Mount Vernon, IL 62864-2347 | 2006-08-12 |
| 1619989555 | Marillen L Wells | Dietitian, Registered | 3307 Broadway St, Ste 140, Mount Vernon, IL 62864-2347 | 2006-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396263000 | Rockcastle County Hospital, Inc. | Clinic/Center | 1770 Lake Cumberland Rd, Mount Vernon, KY 40456-8431 | 2017-09-01 |
| 1578090403 | Advanced Family Medical Clinic Mount Vernon | Clinic/Center | 50 Lovell Court, Mount Vernon, KY 40456-2964 | 2017-05-23 |
| 1306114004 | Lower Oconee Community Hospital, Inc | Clinic/Center | 421 W Robinson Dr, Mount Vernon, GA 30445-2935 | 2011-12-08 |
| 1871706374 | John Hall Md Rural Health Services | Clinic/Center | 3505 Broadway St Ste A, Mount Vernon, IL 62864-2202 | 2007-05-08 |
| 1164547287 | Lower Oconee Community Hospital, Inc | Clinic/Center | 441 W Broad Street, Mount Vernon, GA 30445-2629 | 2007-03-20 |
| 1497823314 | Southside Medical Clinic Inc | Clinic/Center | 913 South 10th Street, Mount Vernon, IL 62864-5313 | 2006-11-30 |
| 1669466686 | Crossroads Physician Corp | Clinic/Center | 3505 Broadway St, Mount Vernon, IL 62864-2202 | 2005-09-06 |
| 1548264237 | Physician Services Corp of Southern Illinois | Clinic/Center | 8 Cusumano Professional Plaza Dr, Mount Vernon, IL 62864-6736 | 2005-06-09 |
| 1912900234 | Family Care Network, Pllc | Clinic/Center | 2116 E. Section St., Mount Vernon, WA 98274 | 2005-05-31 |
| 1447814405 | National Healthcare of Mt Vernon Inc | Clinic/Center | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2019-04-25 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
Please comment or provide details below to improve the information on PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.