Provider Demographics
NPI:1003919168
Name:MONROE MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:MONROE MEDICAL MANAGEMENT
Other - Org Name:REGIONAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-518-8188
Mailing Address - Street 1:8856 YOUREE DR STE D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2514
Mailing Address - Country:US
Mailing Address - Phone:318-797-8859
Mailing Address - Fax:
Practice Address - Street 1:3736 N MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-3104
Practice Address - Country:US
Practice Address - Phone:318-934-0092
Practice Address - Fax:318-934-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443310Medicaid
LA1443310Medicaid