Provider Demographics
NPI:1205163011
Name:MONARCH DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:MONARCH DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-226-4338
Mailing Address - Street 1:7500 RIALTO BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8531
Mailing Address - Country:US
Mailing Address - Phone:512-213-4131
Mailing Address - Fax:866-255-5732
Practice Address - Street 1:7500 RIALTO BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8531
Practice Address - Country:US
Practice Address - Phone:512-213-4131
Practice Address - Fax:866-255-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211903401Medicaid