Provider Demographics
NPI:1396029153
Name:MONARCH OBSTETRICS MANAGEMENT SERVICES, INC
Entity Type:Organization
Organization Name:MONARCH OBSTETRICS MANAGEMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-627-9284
Mailing Address - Street 1:100 WILLOW PLZ STE 201
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6213
Mailing Address - Country:US
Mailing Address - Phone:559-627-9284
Mailing Address - Fax:559-713-0965
Practice Address - Street 1:100 WILLOW PLZ STE 201
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6213
Practice Address - Country:US
Practice Address - Phone:559-627-9284
Practice Address - Fax:559-713-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79867207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty