NPIMap

Organization Active NPI

Monroe Surgical Hospital, LLC

Doing business as The Medical Office of Mangham

  • Rural Health Clinic/Center
  • Mangham, LA
National Provider Identifier
1871153379
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MONROE SURGICAL HOSPITAL, LLC
Doing business as
The Medical Office of Mangham
Practice address
261 Highway 132
Mangham, LA 71259-5269
Phone
(318) 248-2807
Fax
(318) 248-2967
NPI assigned
Jun 17, 2019
Last updated
Jun 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MONROE SURGICAL HOSPITAL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

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 1

  • The Medical Office of Mangham Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871153379. Details of each certification follow.

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
LLCProprietary
Enrollment address
261 Highway 132
Mangham, LA 71259-5269
Related CCNs
190245

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Monroe Surgical Hospita3 organizations share this tax ID, including this one
Part of
Monroe Surgical Hospita

Other organizations with this tax ID 2

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

Locations

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

Ownership & related parties

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 EmployeeDirector of Nursing Sep 1, 2019
Robyn J Hemphill Individual Corporate DirectorCeo Jan 1, 2013
W-2 Managing EmployeeCeo Nov 13, 2019

Facilities with the same owner 1

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

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.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560816000000",
    "number": "1871153379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51193",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051193",
            "telephone_number": "318-248-2807",
            "fax_number": "318-248-2967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 HIGHWAY 132",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "712595269",
            "telephone_number": "318-248-2807",
            "fax_number": "318-248-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE SURGICAL HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONROE SURGICAL HOSPITAL, LLC",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-18",
        "status": "A",
        "authorized_official_last_name": "HEMPHILL",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-812-9500",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medical Office of Mangham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mangham, LA

Sources for this page

Verify at the official NPI Registry.