| Mt Vernon Family Practice Pc | |
|
4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 | |
| (618) 244-6770 | |
| (618) 244-6772 |
| Full Name | Mt Vernon Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4230 Lincolnshire Dr Ste G, Mount Vernon, Illinois |
| Authorized Official Name and Position | Linden R Pearson (PRESIDENT) |
| Authorized Official Contact | 6182446770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mt Vernon Family Practice Pc 4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 Ph: (618) 244-6770 | Mt Vernon Family Practice Pc 4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 Ph: (618) 244-6770 |
| NPI Number | 1215141916 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215141916 | NPI | - | NPPES |
| 174857 | Other | IL | HEALTHLINK PPO HMO |
| 036063418 | Medicaid | IL | |
| 080168274 | Other | IL | MEDICARE RAILROAD NUMBER |
| 355486181 | Other | IL | TRICARE PROVIDER NUMBER |
| 04127526 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036063418 (Illinois) | Primary |
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