| Mount Vernon Medical Enterprises Inc | |
|
4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 | |
| (618) 244-6770 | |
| (618) 244-6772 |
| Full Name | Mount Vernon Medical Enterprises Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4230 Lincolnshire Dr Ste G, Mount Vernon, Illinois |
| Authorized Official Name and Position | Suzanne Alt (PRESIDENT) |
| Authorized Official Contact | 6603413877 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mount Vernon Medical Enterprises Inc 4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 Ph: (618) 244-6770 | Mount Vernon Medical Enterprises Inc 4230 Lincolnshire Dr Ste G Mount Vernon IL 62864-2189 Ph: (618) 244-6770 |
| NPI Number | 1548877947 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 09/29/2020 |
| Medicare PECOS PAC ID | 0244643393 |
|---|---|
| Medicare Enrollment ID | O20210108001228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548877947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208VP0000X | Pain Medicine - Pain Medicine | (* (Not Available)) | Secondary |
| Provider Name | Suzanne E Alt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811995566 PECOS PAC ID: 9931124781 Enrollment ID: I20111117000327 |
| Provider Name | Craig H Dutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619584653 PECOS PAC ID: 9032562350 Enrollment ID: I20240201004338 |
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