Healthcare Provider Details

I. General information

NPI: 1992178552
Provider Name (Legal Business Name): MONROE COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MEDICAL CENTER DR
MONROEVILLE AL
36460
US

IV. Provider business mailing address

PO BOX 886
MONROEVILLE AL
36461-0886
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-3266
  • Fax: 251-575-3262
Mailing address:
  • Phone: 251-743-7485
  • Fax: 251-743-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY S JOHNSON
Title or Position: PFS MANAGER
Credential:
Phone: 251-743-7485