Physician Rural Health Clinic of Jefferson County
NPI #1649283870 in Mount Vernon, Illinois
Provider Information
- NPI Number
- 1649283870
- Entity Type
- Organization
- Organization Name
- Physician Rural Health Clinic of Jefferson County
- Primary Specialty
- Clinic/Center - Rural Health
- Enumeration Date
- Aug 15, 2006
- Last Updated
- Oct 15, 2008
Practice Location
- Address
- 3307 BROADWAY ST
- Address 2
- STE 130
- City
- Mount Vernon
- State
- Illinois
- ZIP Code
- 62864-2347
- Phone
- (618) 244-2560
Authorized Official
- Name
- VEENA K GUPTA, M.D.
- Title
- CEO
- Phone
- (618) 244-7200
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Rural Health — Rural Health |
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