Provider Demographics
NPI:1447436829
Name:THE MONROE MEDICAL FOUNDATION FOR RESEARCH AND EDUCATION, INC
Entity type:Organization
Organization Name:THE MONROE MEDICAL FOUNDATION FOR RESEARCH AND EDUCATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CCRC
Authorized Official - Phone:608-324-2290
Mailing Address - Street 1:411 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1576
Mailing Address - Country:US
Mailing Address - Phone:608-324-2670
Mailing Address - Fax:608-324-2363
Practice Address - Street 1:411 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1576
Practice Address - Country:US
Practice Address - Phone:608-324-2670
Practice Address - Fax:608-324-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI562979OtherDEAN HEALTH PLAN