Healthcare Provider Details

I. General information

NPI: 1558364034
Provider Name (Legal Business Name): COUNTY OF MONROE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W OAK ST STE B
SPARTA WI
54656-2150
US

IV. Provider business mailing address

315 W OAK ST STE B
SPARTA WI
54656-2150
US

V. Phone/Fax

Practice location:
  • Phone: 608-269-8666
  • Fax: 608-269-8872
Mailing address:
  • Phone: 608-269-8666
  • Fax: 608-269-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA DAVIS
Title or Position: PROGRAM ASSOCIATE
Credential:
Phone: 608-269-8666