Provider Demographics
NPI:1295830628
Name:THE MONROE CLINIC, INC.
Entity Type:Organization
Organization Name:THE MONROE CLINIC, INC.
Other - Org Name:THE MONROE CLINIC HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZINSLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-324-2770
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:608-324-2000
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:608-324-2000
Practice Address - Fax:608-324-2469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MONROE CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142251E00000X
IL1003052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41515200Medicaid
WI41515200Medicaid
IL=========007Medicaid