MT VERNON FAMILY PRACTICE PC NPI 1215141916

NPI Information

  • NPI: 1215141916
  • Provider Name: MT VERNON FAMILY PRACTICE PC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 14D1013305
  • Address: 4230 LINCOLNSHIRE DR STE G
    MOUNT VERNON, IL
    ZIP 62864
  • Phone: (618) 244-6770

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NPI Details

MT VERNON FAMILY PRACTICE PC is a family medicine in Mount Vernon, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MT VERNON FAMILY PRACTICE PC NPI is 1215141916. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4230 LINCOLNSHIRE DR STE G
MOUNT VERNON, IL
ZIP 62864-189
Phone: (618) 244-6770
Fax: (618) 244-6772

The provider's authorized official is Linden R Pearson .
The authorized official title is President and has the following contact phone number (618) 244-6770.

The CLIA number assigned to this NPI record is 14D1013305 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/10/2007 and was last updated on 8/12/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036063418ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1036063418MEDICAIDILLINOIS
2355486181OTHERILLINOISTRICARE PROVIDER NUMBER
3080168274OTHERILLINOISMEDICARE RAILROAD NUMBER
404127526OTHERILLINOISBCBS
5C45162MEDICARE UPINILLINOIS
6174857OTHERILLINOISHEALTHLINK PPO HMO
7208777MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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