1871544585 NPI number — WOMAN'S CLINIC OF MONROE, AMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871544585 NPI number — WOMAN'S CLINIC OF MONROE, AMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMAN'S CLINIC OF MONROE, AMC
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:
Provider Other Organization Name Type Code:
6
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:
1871544585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 GRAMMONT ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-7457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-388-4030
Provider Business Mailing Address Fax Number:
318-998-3999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 GRAMMONT ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-7457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-388-4030
Provider Business Practice Location Address Fax Number:
318-325-8437
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF INSURANCE
Authorized Official Telephone Number:
318-388-4030

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1107581 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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