=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447436829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MONROE MEDICAL FOUNDATION FOR RESEARCH AND EDUCATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 22ND AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-324-2670
-----------------------------------------------------
Fax | 608-324-2363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 22ND AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-324-2670
-----------------------------------------------------
Fax | 608-324-2363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. PATRICIA L BERRA
-----------------------------------------------------
Credential | CCRC
-----------------------------------------------------
Telephone | 608-324-2290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------