MEDICARE: MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1912440298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES

Provider Business Mailing Address
First Line	:	PO BOX 590
Second Line	:
City	:	UNION
State	:	WV
Zip	:	24983-0590
Country	:	US
Telephone Number	:	304-772-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 JAMES MONROE DR
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951-7168
Country	:	US
Telephone Number	:	304-753-5940
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MICHELLE BALLARD
Credential	:
Telephone Number	:	304-772-3034

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/23/2022

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