Provider Demographics
NPI:1083854434
Name:MONROE MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MONROE MEDICAL FOUNDATION, INC.
Other - Org Name:MONROE COUNTY MEDICAL CENTER MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICH-MCLERRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-487-9231
Mailing Address - Street 1:604 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-1128
Mailing Address - Country:US
Mailing Address - Phone:270-487-9231
Mailing Address - Fax:270-487-5784
Practice Address - Street 1:604 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1128
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:2009-02-25
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6592847500Medicaid
KY3954OtherGROUP