1558364034 NPI number — COUNTY OF MONROE

Table of content: (NPI 1558364034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558364034 NPI number — COUNTY OF MONROE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MONROE
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:
MONROE COUNTY HEALTH DEPARTMENT
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:
1558364034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 W OAK ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54656-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-269-8666
Provider Business Mailing Address Fax Number:
608-269-8872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W OAK ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54656-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-269-8666
Provider Business Practice Location Address Fax Number:
608-269-8872
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM ASSOCIATE
Authorized Official Telephone Number:
608-269-8666

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43086500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41861000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44008300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41522800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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