Organization
MT VERNON RADIATION THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD HUNTINGTON (VICE PRESIDENT BUSINESS DEVELOPMENT)
(618) 241-2204
Entity
Organization
Contact information
Practice address
4117 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 241-1827
Mailing address
PO BOX 504229, SAINT LOUIS, MO 63150-0001
(618) 241-1827
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276923
GROUP HEALTH PLAN
IL
01
—
4132037
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/28/2006
Last updated
07/21/2022
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