Provider Demographics
NPI:1871544585
Name:WOMAN'S CLINIC OF MONROE, AMC
Entity type:Organization
Organization Name:WOMAN'S CLINIC OF MONROE, AMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-4030
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-388-4030
Mailing Address - Fax:318-998-3999
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-388-4030
Practice Address - Fax:318-325-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1107581Medicaid
LA4Q1705C148Medicare PIN