Provider Demographics
NPI:1760660567
Name:REGINALD L VERNIER
Entity Type:Organization
Organization Name:REGINALD L VERNIER
Other - Org Name:BRUSH CREEK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-783-8713
Mailing Address - Street 1:500 S SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1665
Mailing Address - Country:US
Mailing Address - Phone:618-783-8713
Mailing Address - Fax:618-783-4170
Practice Address - Street 1:500 S SCOTT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1665
Practice Address - Country:US
Practice Address - Phone:618-783-8713
Practice Address - Fax:618-783-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082451261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health