=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164806444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONROE HOSOITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2015
-----------------------------------------------------
Last Update Date | 07/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4011 MONROE MEDICAL PARK
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-825-1111
-----------------------------------------------------
Fax | 812-825-0786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4011 S MONROE MEDICAL PARK BLVD
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-825-1111
-----------------------------------------------------
Fax | 812-825-0786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE VERIFICATION SPECIALIST
-----------------------------------------------------
Name | KASIE PAULING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-825-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------