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General NPI Number Information
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NPI Number | 1558364034
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Entity Type | Organization
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Legal Business Name | COUNTY OF MONROE
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 315 W OAK ST STE B
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City | SPARTA
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State | WI
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Zip | 54656-2150
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Country | US
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Telephone | 608-269-8666
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Fax | 608-269-8872
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Provider Business Mailing Address
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Address Line | 315 W OAK ST STE B
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City | SPARTA
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State | WI
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Zip | 54656-2150
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Country | US
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Telephone | 608-269-8666
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Fax | 608-269-8872
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Authorized Official
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Title or Position | PROGRAM ASSOCIATE
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Name | LAURA DAVIS
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Credential |
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Telephone | 608-269-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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