Provider Demographics
NPI:1295819019
Name:THE MONROE CLINIC, INC.
Entity Type:Organization
Organization Name:THE MONROE CLINIC, INC.
Other - Org Name:SSM HEALTH MONROE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CURRAN-MEULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-324-2625
Mailing Address - Street 1:515 22ND AVE
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:608-324-2770
Mailing Address - Fax:608-324-2469
Practice Address - Street 1:515 22ND AVE
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:608-324-2770
Practice Address - Fax:608-324-2469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MONROE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7352-0423336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33076000Medicaid
0286360001Medicare ID - Type Unspecified