Basic Information
| Provider Information | |||||||||
| NPI: | 1033559844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MVHE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONROE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 OVERBROOK DR STE C | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450501147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374998273 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 OVERBROOK DR STE C | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450501147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374998273 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | PRUNIER | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9374996762 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0088150 | 05 | OH | MEDICAID |