Provider Demographics
NPI:1043412166
Name:MONROE MEDICAL FOUNDATION INC
Entity Type:Organization
Organization Name:MONROE MEDICAL FOUNDATION INC
Other - Org Name:MONROE COUNTY MEDICA CENTER HHA EPSDT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-487-9231
Mailing Address - Street 1:529 CAPP HARLAN ROAD
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167
Mailing Address - Country:US
Mailing Address - Phone:270-487-9231
Mailing Address - Fax:270-487-5784
Practice Address - Street 1:417 CAPP HARLAN ROAD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45348232Medicaid