Provider Demographics
NPI:1548582034
Name:MONROE COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CENTER
Other - Org Name:CRAIG COUNTY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-772-3065
Mailing Address - Street 1:200 HEALTH CENTER DRIVE
Mailing Address - Street 2:PO BOX 590
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983
Mailing Address - Country:US
Mailing Address - Phone:304-772-3065
Mailing Address - Fax:
Practice Address - Street 1:230 MARKET STREET
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127
Practice Address - Country:US
Practice Address - Phone:540-864-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548582034Medicaid
WV1548582034Medicaid