Provider Demographics
NPI:1922302900
Name:CHARLES W. MONDAY, JR., M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES W. MONDAY, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:936-295-9101
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-1920
Mailing Address - Country:US
Mailing Address - Phone:936-295-9101
Mailing Address - Fax:936-295-5977
Practice Address - Street 1:130 MEDICAL CENTER PKWY STE 6
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4943
Practice Address - Country:US
Practice Address - Phone:936-295-9101
Practice Address - Fax:936-295-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3345208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115078103Medicaid
TX115078103Medicaid