PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY NPI 1649283870

NPI Information

NPI: 1649283870
Provider Name: PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
3307 BROADWAY ST
STE 130
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 244-2560
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PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY is a rural health clinic center in Mount Vernon, IL. PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY NPI is 1649283870. The provider is registered as an organization entity type.

The provider's business location address is:

3307 BROADWAY ST
STE 130
MOUNT VERNON, IL
ZIP 62864-347
Phone: (618) 244-2560
Fax: (618) 244-1572

The provider's authorized official is Veena K Gupta .
The authorized official title is Ceo and has the following contact phone number (618) 244-7200.

The enumeration date for this NPI number is 8/15/2006 and was last updated on 10/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	143949	MEDICARE OSCAR/CERTIFICATION	ILLINOIS
2	=========001	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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