Provider Demographics
NPI:1992734487
Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Entity type:Organization
Organization Name:MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-772-3064
Mailing Address - Street 1:200 HEALTH CENTER DRIVE
Mailing Address - Street 2:PO BOX 590
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983
Mailing Address - Country:US
Mailing Address - Phone:304-772-3064
Mailing Address - Fax:304-772-3296
Practice Address - Street 1:200 HEALTH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WV
Practice Address - Zip Code:24983
Practice Address - Country:US
Practice Address - Phone:304-772-3064
Practice Address - Fax:304-772-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035243000Medicaid
WV001706775OtherBC/BS
WV5611053OtherAETNA
WVDB2513OtherMEDICARE RR GROUP
WV0035243000Medicaid
WV5118371Medicare PIN