Provider Demographics
NPI:1013189604
Name:MUNROE REGIONAL HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:MUNROE REGIONAL HEALTH SYSTEM INC
Other - Org Name:MUNROE PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-351-7200
Mailing Address - Street 1:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-867-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281125100Medicaid
FL33016OtherBCBS OF FL
FL281125100Medicaid
FL33016OtherBCBS OF FL