Organization
BYRD-WATSON SOUTH 9TH DRUG CO
Active
Other names
Byrd-Watson Medical Downtown
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM BREEZE (OFFICER OF THE CORPORATION)
(618) 244-5400
Entity
Organization
Contact information
Practice address
1200 MAIN ST, MOUNT VERNON, IL 62864-3821
(618) 242-2800
(618) 244-4816
Mailing address
PO BOX 1179, MOUNT VERNON, IL 62864-0024
(618) 242-2800
(618) 242-6775
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140146
HEALTH ALLIANCE
IL
01
—
177625
HEALTHLINK
IL
01
—
4132044
BCBS OF IL
IL
Enumeration date
10/06/2005
Last updated
05/28/2025
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