Healthcare Provider Details

I. General information

NPI: 1548582034
Provider Name (Legal Business Name): MONROE COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARKET STREET
NEW CASTLE VA
24127
US

IV. Provider business mailing address

200 HEALTH CENTER DRIVE PO BOX 590
UNION WV
24983
US

V. Phone/Fax

Practice location:
  • Phone: 540-864-5556
  • Fax:
Mailing address:
  • Phone: 304-772-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411129
License Number StateVA

VIII. Authorized Official

Name: MICHELLE B BALLARD
Title or Position: COO
Credential:
Phone: 304-772-3065