MT VERNON RADIATION THERAPY CENTER (NPI# 1952477028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1952477028 |
Entity Type | Organization |
Organization Name | MT VERNON RADIATION THERAPY CENTER |
Practice Address |
4117 Veterans Memorial Dr Mount Vernon IL 62864-6262 |
Mailing Address |
Po Box 504229 Saint Louis MO 63150-0001 |
Practice Telephone | 6182411827 |
Mailing Telephone | 6182411827 |
Enumeration Date | 2006-11-28 |
Last Update Date | 2009-10-05 |
Authorized Official Name | MR. RICHARD HUNTINGTON (VICE PRESIDENT BUSINESS DEVELOPMENT) |
Authorized Official Telephone | 6182412204 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QX0203X |
Clinic/Center Specialization: Oncology, Radiation |
========= | IL | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | GROUP HEALTH PLAN | 276923 | 01 |
IL | BLUE CROSS BLUE SHIELD | 4132037 | 01 |
Street Address |
4117 VETERANS MEMORIAL DR |
City | MOUNT VERNON |
State | IL |
Zip Code | 62864-6262 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912984766 | Yagnesh V. Oza | Internal Medicine | 4117 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2005-12-22 |
1740582246 | Avani Changela | Internal Medicine | 4117 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2010-12-03 |
1407004773 | Kathleen Marie Naegele | Internal Medicine | 4117 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2008-08-28 |
1316000219 | Gloria Nicole Abenes | Nurse Practitioner | 4117 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2006-12-19 |
1053364885 | Oza Oncology Inc. | Radiology | 4117 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 | 2006-05-19 |
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 | 261QX0203X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Oncology, Radiation |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194220897 | South Campus Partners, Inc. | Clinic/Center | 15300 West Ave Bldg A, Orland Park, IL 60462-4600 | 2018-03-26 |
1316202344 | Skan LLC | Clinic/Center | 3425 Drew Avenue, Suite A, Sandwich, IL 60548-2351 | 2012-07-05 |
1144327487 | Northern Illinois University | Clinic/Center | Kirk and Pine Rd, Batavia, IL 60510 | 2006-09-20 |
1134233950 | Bharat S Jailwala | Clinic/Center | 846 Dundee Ave, Elgin, IL 60120-3068 | 2006-08-18 |
1407818644 | Freeport Regional Health Care Services | Clinic/Center | 1163 W Stephenson St, Freeport, IL 61032-4866 | 2006-04-04 |
1497314462 | Highland Oncology, Ltd | Clinic/Center | 208 Flax Dr, Highland, IL 62249-1375 | 2019-06-12 |
1972824142 | Illinois Proton Center LLC | Clinic/Center | 4455 Weaver Pkwy, Warrenville, IL 60555-3269 | 2010-06-22 |
1750401196 | American Cancer Center | Clinic/Center | 846 Dundee Ave, Elgin, IL 60120-3068 | 2007-03-30 |
1720185150 | Morris Hospital | Clinic/Center | 1600 W Us Route 6, Morris, IL 60450 | 2006-09-20 |
City | MOUNT VERNON |
Zip Code | 62864 |
Please comment or provide details below to improve the information on MT VERNON RADIATION THERAPY CENTER.
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.