Provider Demographics
NPI:1457570541
Name:MONROE FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:MONROE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-825-5191
Mailing Address - Street 1:3209 W FULLERTON PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4057
Mailing Address - Country:US
Mailing Address - Phone:812-825-5191
Mailing Address - Fax:812-825-5197
Practice Address - Street 1:3209 W FULLERTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4057
Practice Address - Country:US
Practice Address - Phone:812-825-5191
Practice Address - Fax:812-825-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252340Medicare PIN