Healthcare Provider Details

I. General information

NPI: 1962697102
Provider Name (Legal Business Name): MONROE SURGICAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 BROADMOOR BLVD
MONROE LA
71201-2963
US

IV. Provider business mailing address

2408 BROADMOOR BLVD
MONROE LA
71201-2963
US

V. Phone/Fax

Practice location:
  • Phone: 318-410-0002
  • Fax: 318-410-1960
Mailing address:
  • Phone: 318-410-0002
  • Fax: 318-410-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number475
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBYN J. HEMPHILL
Title or Position: CEO/CNO
Credential:
Phone: 318-410-0002