Provider Demographics
NPI: | 1558521138 |
---|---|
Name: | MONROE COUNTY HEALTH DEPARTMENT |
Entity type: | Organization |
Organization Name: | MONROE COUNTY HEALTH DEPARTMENT |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JILL |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | FORD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 270-487-6782 |
Mailing Address - Street 1: | 452 EAST 4TH STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | TOMPKINSVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42167-1667 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 270-487-6782 |
Mailing Address - Fax: | 270-487-5457 |
Practice Address - Street 1: | 600 S MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | TOMPKINSVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42167-1552 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-487-9624 |
Practice Address - Fax: | 270-487-5457 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-17 |
Last Update Date: | 2014-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251K00000X | Agencies | Public Health or Welfare |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100062210 | Medicaid |