Provider Demographics
NPI:1558364034
Name:COUNTY OF MONROE
Entity Type:Organization
Organization Name:COUNTY OF MONROE
Other - Org Name:MONROE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-269-8666
Mailing Address - Street 1:315 W OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2150
Mailing Address - Country:US
Mailing Address - Phone:608-269-8666
Mailing Address - Fax:608-269-8872
Practice Address - Street 1:315 W OAK ST STE B
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2150
Practice Address - Country:US
Practice Address - Phone:608-269-8666
Practice Address - Fax:608-269-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43086500Medicaid
WI41861000Medicaid
WI44008300Medicaid
WI41522800Medicaid
WI41522800Medicaid