Provider Demographics
NPI:1992178552
Name:MONROE COUNTY HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CARE AUTHORITY
Other - Org Name:MCH MONROEVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-743-7485
Mailing Address - Street 1:PO 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:251-743-7485
Mailing Address - Fax:251-743-7445
Practice Address - Street 1:16 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460
Practice Address - Country:US
Practice Address - Phone:251-575-3266
Practice Address - Fax:251-575-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty