Organization
ALS MOUNT VERNON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF DEGYANSKY (VP OF OPERATIONS)
(330) 620-7828
Entity
Organization
Contact information
Practice address
1135 GAMBIER RD, MOUNT VERNON, OH 43050-3839
(740) 415-1138
Mailing address
26261 MAIN ST, COOLVILLE, OH 45723-9204
(740) 350-9095
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0234954
—
OH
01
—
2630N
LICENSURE
OH
Enumeration date
05/27/2021
Last updated
07/05/2023
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