1700835345 NPI number — CAROL MONROE NP

Table of content: CAROL MONROE NP (NPI 1700835345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700835345 NPI number — CAROL MONROE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONROE
Provider First Name:
CAROL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1700835345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 E 20TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-624-4701
Provider Business Mailing Address Fax Number:
417-624-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 E 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-624-4701
Provider Business Practice Location Address Fax Number:
417-624-9807
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  107694 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00248185 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100052650A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 428635916 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126077 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100314760C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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