Provider Demographics
NPI:1053499350
Name:MONROE MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MONROE MEDICAL FOUNDATION, INC.
Other - Org Name:MONROE COUNTY MEDICAL CENTER
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 RD
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-1808
Mailing Address - Country:US
Mailing Address - Phone:270-487-9231
Mailing Address - Fax:270-487-5784
Practice Address - Street 1:529 CAPP HARLAN RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1808
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100338282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0180105Medicaid
KY1072280OtherPASSPORT HEALTH MEDICAID
TN8984OtherTENNCARE SELECT
KY2434998000OtherPASSPORT ADVANTAGE
KY000000054261OtherBLUE CROSS BLUE SHIELD
KY01003326Medicaid
KY2434998000OtherPASSPORT ADVANTAGE