MEDICARE: MONARCH OBSTETRICS MANAGEMENT SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G79867	CA

General Provider Information

NPI Number	:	1396029153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONARCH OBSTETRICS MANAGEMENT SERVICES, INC

Provider Business Mailing Address
First Line	:	100 WILLOW PLZ STE 201
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-6213
Country	:	US
Telephone Number	:	559-627-9284
Fax Number	:	559-713-0965

Provider Business Practice Location Address
First Line	:	100 WILLOW PLZ STE 201
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-6213
Country	:	US
Telephone Number	:	559-627-9284
Fax Number	:	559-713-0965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK D WISEMAN
Credential	:	M.D.
Telephone Number	:	559-627-9284

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	10/12/2011

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