1023059920 NPI number — MONROE HEALTH VENTURES, INC

Table of content: (NPI 1023059920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023059920 NPI number — MONROE HEALTH VENTURES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE HEALTH VENTURES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MERCY MEMORIAL WESTSIDE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023059920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 N MACOMB ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-240-4520
Provider Business Mailing Address Fax Number:
734-240-4535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 POWELL DR SUITE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-240-3333
Provider Business Practice Location Address Fax Number:
734-240-3334
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKEL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VICE PRESIDENT-FINANCE
Authorized Official Telephone Number:
734-240-4527

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  5301008257 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2367856 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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