Provider Demographics
NPI:1912440298
Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Other - Org Name:JAMES MONROE WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-772-3034
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0590
Mailing Address - Country:US
Mailing Address - Phone:304-772-3064
Mailing Address - Fax:
Practice Address - Street 1:142 JAMES MONROE DR
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7168
Practice Address - Country:US
Practice Address - Phone:304-753-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)