Provider Demographics
NPI:1851585046
Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Other - Org Name:CRAIG COUNTY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-772-3064
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:200 HEALTH CENTER DRIVE
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983
Mailing Address - Country:US
Mailing Address - Phone:304-772-3064
Mailing Address - Fax:304-772-3296
Practice Address - Street 1:226 MARKET STREET
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127-0370
Practice Address - Country:US
Practice Address - Phone:540-864-6390
Practice Address - Fax:540-864-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851585046Medicaid
VAA104451OtherGROUP PTAN
VA491881Medicare Oscar/Certification