Monroe Medical Foundation Inc
Organization Active NPI Rural Health Clinic/Center · Tompkinsville, KY
NPI 1629655816 · NPPES record last updated Mar 25, 2021
Key facts
- NPI
- 1629655816
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MONROE MEDICAL FOUNDATION INC
- Practice address
- 604 N Main St
Tompkinsville, KY 42167-1128 - Phone
- (270) 407-5150
- NPI assigned
- Mar 25, 2021
- Organization subpart
- No
Authorized official
- Name
- Alisa Nichole Melton
- Title
- Asst. C.F.O.
- Phone
- (270) 487-9231
Owners & managing parties with NPI records 3
-
Jack D Anderson, DO
-
Willie F Ross Jr., O.D.
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 12
Related certifications (CCN) 1
Practitioners 30
-
Jack D Anderson, DO
-
Scott Brian Babin, M.D.
-
Jerry Neal Bean, M.D.
-
Paul Bunn, M.D.
-
Kevin Lyn Burner, M.D.
-
Ryan Patrick Currier, M.D.
-
Kimberly Yvonne Eakle, M.D.
-
Timothy Dale Hume, M.D.
-
Laura Inabnitt, DO
-
Sean Michael Ladson, M.D.
-
Brent A. Madison, M.D.
-
Caylan McPherson, DO
-
Adil M Mohiuddin, M.D.
-
William Ronald Shanks, M.D.
-
Jason Matthew White, M.D.
-
Victor L Zirilli, M.D.
-
Borzou Azima, MD
-
Erik E Dowden, MD
-
Stephen B Eigles, M.D.
-
Edmund D Harris, MD
-
Matthew A Hrastich, D.O.
-
Mark D Nowell, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D1093981 | Monroe County Physician Associates | Certificate of waiver | Jan 6, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Rural health clinic certification: CCN 188544
- Legal name
- MONROE MEDICAL FOUNDATION, INC.
- Doing business as
- MONROE COUNTY PHYSICIAN ASSOCIATES
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 11, 2022
- Last certification
- Oct 23, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 5, 1979 in KY
- Enrollment address
- 604 N Main St
Tompkinsville, KY 42167-1128 - Related CCNs
- 180105
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Andrea L Rich-McLerran |
Corporate Officer |
Jan 1, 2021 | |
| W-2 Managing Employee |
Jan 1, 2021 | ||
| Jimmy B Goodman |
Corporate Director |
Jan 1, 1979 | |
| Willie F. Ross |
Corporate Director |
Nov 1, 1983 | |
| Donnie Peden |
Corporate Director |
Jul 1, 2022 | |
| Gregory K Crabtree |
Corporate Director |
Oct 1, 2001 | |
| Caitlin Hagan |
Corporate Officer |
Aug 1, 2023 | |
| W-2 Managing Employee |
Aug 1, 2023 | ||
| Anthony C Carter |
Corporate Director |
Jan 1, 2022 | |
| Alisa N Melton |
W-2 Managing Employee |
Apr 15, 2021 | |
| Judith a Rowland |
Corporate Director |
May 1, 2001 | |
| Jack D Anderson |
Corporate Director |
Jan 1, 2023 | |
| Pauline M Baker |
Corporate Officer |
Apr 1, 1995 | |
| Corporate Director |
Apr 1, 1995 | ||
| Kem Coe |
Corporate Director |
Aug 17, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210709002728 | KY | Part a Provider - Rural Health Clinic | 5092702472 | Practice locations: Tompkinsville, KY |
National Provider Directory
- Tax ID family
- Monroe Medical Foundation Inc
Locations
1515 Edmonton Rd
Tompkinsville, KY 42167
Phone (270) 487-9272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
604 N Main St
Tompkinsville, KY 42167-1128
Mailing address
529 Capp Harlan Rd
Tompkinsville, KY 42167-1808
Phone (270) 487-9231
Other names
- Monroe County Physician Associates
Other providers in Tompkinsville, KY
- Monroe County Health Department
- Monroe County Health Department
- Monroe Medical Equipment Co LLC
- Monroe Medical Foundation Inc
- Monroe Medical Foundation Inc
- Monroe Medical Foundation Inc
- Monroe Medical Foundation Inc
- Monroe Medical Foundation Inc
- Monroe Medical Foundation, Inc.
- Monroe Medical Foundation, Inc.
All providers in Tompkinsville, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.