# PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649283870
- **Authorized official:** VEENA K GUPTA M.D. (CEO)
- **Authorized official phone:** (618) 244-7200

## Contact information

- **Practice address:** 3307 BROADWAY ST, STE 130, MOUNT VERNON, IL 62864-2347
- **Practice address phone:** (618) 244-2560
- **Practice address fax:** (618) 244-1572
- **Mailing address:** 3307 BROADWAY ST, STE 130, MOUNT VERNON, IL 62864-2347
- **Mailing address phone:** (618) 244-2560
- **Mailing address fax:** (618) 244-1572

## Taxonomy

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

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 10/15/2008