Provider Demographics
NPI:1962697102
Name:MONROE SURGICAL HOSPITAL
Entity type:Organization
Organization Name:MONROE SURGICAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CNO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-410-0002
Mailing Address - Street 1:2408 BROADMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2963
Mailing Address - Country:US
Mailing Address - Phone:318-410-0002
Mailing Address - Fax:318-410-1960
Practice Address - Street 1:2408 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2963
Practice Address - Country:US
Practice Address - Phone:318-410-0002
Practice Address - Fax:318-410-1960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONROE SURGICAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
LA475282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443735Medicaid
LAG3230OtherBLUE CROSS BLUE SHIELD
LAG3230OtherBLUE CROSS BLUE SHIELD