Healthcare Provider Details

I. General information

NPI: 1386983799
Provider Name (Legal Business Name): MONROE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 HANCOCK DR
ORANGEVILLE IL
61060-9698
US

IV. Provider business mailing address

229 HANCOCK DR
ORANGEVILLE IL
61060-9698
US

V. Phone/Fax

Practice location:
  • Phone: 563-590-7755
  • Fax:
Mailing address:
  • Phone: 563-590-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number12250-24
License Number StateWI

VIII. Authorized Official

Name: ERIC KATZENBERGER
Title or Position: REHAB SERVICES COACH
Credential:
Phone: 608-324-1730