1982743126 NPI number — STEPHANIE M MONROE D.C., P.C.

Table of content: (NPI 1982743126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982743126 NPI number — STEPHANIE M MONROE D.C., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHANIE M MONROE D.C., P.C.
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:
1982743126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3302 GODFREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GODFREY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62035-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-467-2744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 GODFREY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GODFREY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62035-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-467-2744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONROE
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-467-2744

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 293662 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 06021571 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4400408 . This is a "UHC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 105211 . This is a "BLUE SHIELD OF MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5178160 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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