Provider Demographics
NPI:1538100052
Name:MONROE COUNTY HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CARE AUTHORITY
Other - Org Name:MCH SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-575-3111
Mailing Address - Street 1:P.O. BOX 886
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36461-0886
Mailing Address - Country:US
Mailing Address - Phone:251-575-3111
Mailing Address - Fax:251-743-7445
Practice Address - Street 1:2016 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460
Practice Address - Country:US
Practice Address - Phone:251-743-7486
Practice Address - Fax:251-743-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529908490Medicaid
J251Medicare PIN