# NATIONAL HEALTHCARE OF MT VERNON INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crossroads Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619602604
- **Authorized official:** RANDY MICHAEL COOPER (SVP FINANCE OP)
- **Authorized official phone:** (615) 221-3840

## Contact information

- **Practice address:** 205 BAILEY LN STE F, BENTON, IL 62812-1921
- **Practice address phone:** (618) 882-4200
- **Practice address fax:** (618) 882-4208
- **Mailing address:** PO BOX 5009, BRENTWOOD, TN 37024-5009
- **Mailing address phone:** (615) 221-3722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/22/2022
- **Last updated:** 07/22/2022