National Healthcare of Mt Vernon Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

0003947 Issued in IL

Legal business name

NATIONAL HEALTHCARE OF MT VERNON INC

Doing business as

Crossroads Family Medicine of Benton

Practice address

905 W Washington St Ste a
Benton, IL 62812

Phone

(618) 435-2229

NPI assigned

Sep 19, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tara P Richardson

Title

Authorized Official

Phone

(615) 221-3672

Specialties & licenses 1

Addresses

Other names 1

• Crossroads Family Medicine of Benton Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1982955712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "800-709-7338",
            "fax_number": "615-469-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 W WASHINGTON ST STE A",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "62812",
            "telephone_number": "618-435-2229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4101 N Water Tower Pl",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628646296",
            "country_code": "US",
            "telephone_number": "618-244-4313",
            "fax_number": "618-244-9592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NATIONAL HEALTHCARE OF MT VERNON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-221-3672"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0003947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Medicine of Benton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mission Care of Illinois, LLC
• Carrie Mocaby
• Anna Denise Moyer
• National Healthcare of Mt Vernon Inc
• National Healthcare of Mt Vernon Inc
• Valentine Ogbodo, MD
• Christopher J Ostromecki, M.D.
• Colin Jacob Overstreet, DPT
• Jason Scott Ozbourn
• Lisa Page

• Rural Health Clinic/Center in Benton, IL
• Providers in Benton, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.