NPIMap

Monroe Surgical Hospital, LLC

Organization Active NPI Rural Health Clinic/Center · Mangham, LA

NPI 1871153379 · NPPES record last updated Jun 18, 2019

Key facts

NPI
1871153379
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MONROE SURGICAL HOSPITAL, LLC
Practice address
261 Highway 132
Mangham, LA 71259-5269
Phone
(318) 248-2807
Fax
(318) 248-2967
NPI assigned
Jun 17, 2019
Organization subpart
Yes
Parent organization (as reported)
MONROE SURGICAL HOSPITAL, LLC

Authorized official

Name
Robyn Hemphill, RN
Title
Ceo
Phone
(318) 812-9500

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Rural health clinic certification: CCN 198522

Legal name
MONROE SURGICAL HOSPITAL, LLC
Doing business as
THE MEDICAL OFFICE OF MANGHAM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 17, 2020
Last certification
Jun 17, 2023
Ownership / control type
1B
Organization structure
LLC · Proprietary
Enrollment address
261 Highway 132
Mangham, LA 71259-5269
Related CCNs
190245

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elehealth Medical Group LLC
Organization · Baton Rouge, LA
LLC 		5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
La Helath and Indemnity Co
Organization · Baton Rouge, LA
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Jul 1, 2019 100%
Sharon Tackett
Individual 		W-2 Managing Employee
Director of Nursing		 Sep 1, 2019
Robyn J Hemphill
Individual 		Corporate Director
Ceo		 Jan 1, 2013
W-2 Managing Employee
Ceo		 Nov 13, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20191210000678 LA Part a Provider - Rural Health Clinic 5294725297 Practice locations: Mangham, LA

National Provider Directory

Tax ID family
Monroe Surgical Hospital (3 organizations share this tax ID)
Part of
Monroe Surgical Hospital

Locations

261 Highway 132
Mangham, LA 71259
Phone (318) 248-2807

2516 Broadmoor Blvd
Ste 1C
Monroe, LA 71201
Phone 318410000230705

2516 Broadmoor Blvd
Ste 2B
Monroe, LA 71201
Phone (318) 322-7726

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

261 Highway 132
Mangham, LA 71259-5269

Mailing address

PO Box 51193
Lafayette, LA 70505-1193
Phone (318) 248-2807

Other names

  • The Medical Office of Mangham Doing business as

Other providers in Mangham, LA

All providers in Mangham, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.