Provider Demographics
NPI:1003148677
Name:THE MONROE CLINIC, INC.
Entity Type:Organization
Organization Name:THE MONROE CLINIC, INC.
Other - Org Name:SSM HEALTH MONROE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAT/ATC
Authorized Official - Phone:262-224-2664
Mailing Address - Street 1:515 22ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVENUE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1128-39261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service