Healthcare Provider Details

I. General information

NPI: 1295830628
Provider Name (Legal Business Name): THE MONROE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax: 608-324-2469
Mailing address:
  • Phone: 608-324-2000
  • Fax: 608-324-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1003052
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number142
License Number StateWI

VIII. Authorized Official

Name: MS. MARIE S ZINSLI
Title or Position: PFS DIRECTOR
Credential:
Phone: 608-324-2770