Provider Demographics
NPI:1629182233
Name:MONROE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MONROE SURGICAL ASSOCIATES
Other - Org Name:FOCUS WOMEN'S HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MIS
Authorized Official - Phone:812-337-5003
Mailing Address - Street 1:ATTN: MARIA MITCHELL, PO BOX 5997
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407
Mailing Address - Country:US
Mailing Address - Phone:812-337-5003
Mailing Address - Fax:812-337-5010
Practice Address - Street 1:2920 MCINTYRE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4221
Practice Address - Country:US
Practice Address - Phone:812-339-6636
Practice Address - Fax:812-333-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004658A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN222400Medicare ID - Type Unspecified