Provider Demographics
NPI:1316023351
Name:MONROE MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MONROE MEDICAL FOUNDATION, INC.
Other - Org Name:MONROE COUNTY MEDICAL CENTER HOME HEALTH AGENCY
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 1:417 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:270-487-5905
Practice Address - Fax:270-487-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150137251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054262OtherBLUE CROSS BLUE SHIELD
KY34001867Medicaid
KY42010868Medicaid
KY45348232Medicaid
KY43000389Medicaid
KY42010868Medicaid