Provider Demographics
NPI: | 1477962199 |
---|---|
Name: | 4M MONROE MEDICAL SERVICES PLLC |
Entity Type: | Organization |
Organization Name: | 4M MONROE MEDICAL SERVICES PLLC |
Other - Org Name: | 4M MONROE MEDICAL SERVICES PLLC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PROVIDER ENROLLMENT OFFICER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MELISSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REESE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 855-687-0618 |
Mailing Address - Street 1: | 4535 DRESSLER RD NW |
Mailing Address - Street 2: | |
Mailing Address - City: | CANTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44718-2545 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-994-4409 |
Mailing Address - Fax: | 330-492-8489 |
Practice Address - Street 1: | 5640 N ADRIAN HWY |
Practice Address - Street 2: | |
Practice Address - City: | ADRIAN |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49221-8318 |
Practice Address - Country: | US |
Practice Address - Phone: | 844-474-4019 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-06 |
Last Update Date: | 2023-02-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty |