Provider Demographics
NPI:1225031495
Name:MONROE SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:MONROE SURGICAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MHA
Authorized Official - Phone:318-812-9500
Mailing Address - Street 1:2408 BROADMOOR BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-410-0002
Mailing Address - Fax:318-410-1960
Practice Address - Street 1:2408 BROADMOOR BLVD.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-410-0002
Practice Address - Fax:318-410-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA475282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60485OtherBLUE CROSS BLUE SHIELD
LA1700657Medicaid
LA1700657Medicaid