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General NPI Number Information
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NPI Number | 1083854434
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Entity Type | Organization
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Legal Business Name | MONROE MEDICAL FOUNDATION, INC.
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 604 N MAIN ST
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1128
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Country | US
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Telephone | 270-487-9231
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Fax | 270-487-5784
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Provider Business Mailing Address
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Address Line | 604 N MAIN ST
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1128
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Country | US
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Telephone | 270-487-9231
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Fax | 270-487-5784
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Authorized Official
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Title or Position | C.E.O.
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Name | MRS. ANDREA L RICH-MCLERRAN
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Credential |
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Telephone | 270-487-9231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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