Provider Demographics
NPI:1912535022
Name:ST. CLARE HEALTH MISSION OF MONROE COUNTY, INC
Entity Type:Organization
Organization Name:ST. CLARE HEALTH MISSION OF MONROE COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SUEVDENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-366-5343
Mailing Address - Street 1:310 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2142
Mailing Address - Country:US
Mailing Address - Phone:608-366-5343
Mailing Address - Fax:
Practice Address - Street 1:310 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2142
Practice Address - Country:US
Practice Address - Phone:608-366-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336C0002XSuppliersPharmacyClinic Pharmacy