Provider Demographics
NPI:1952814881
Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
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:304-772-3064
Mailing Address - Street 1:200 HEALTH CENTER DRIVE
Mailing Address - Street 2:P.O. BOX 590
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 OLD SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:WV
Practice Address - Zip Code:24935
Practice Address - Country:US
Practice Address - Phone:304-466-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)