Provider Demographics
NPI:1134330848
Name:MONROE MEDICAL FOUNDATION, INC.
Entity type:Organization
Organization Name:MONROE MEDICAL FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-487-9231
Mailing Address - Street 1:529 CAPP HARLAN RD
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-1808
Mailing Address - Country:US
Mailing Address - Phone:270-487-9231
Mailing Address - Fax:270-487-5784
Practice Address - Street 1:529 CAPP HARLAN RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1808
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216827OtherBLUE CROSS
216826OtherBLUE CROSS
111353OtherBLUE CROSS
216826OtherBLUE CROSS