Basic Information
| Provider Information | |||||||||
| NPI: | 1831123942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONROE HOSPITAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
| FaxNumber: | 8128250782 | ||||||||
| Practice Location | |||||||||
| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
| FaxNumber: | 8128250782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | URBAN | ||||||||
| AuthorizedOfficialFirstName: | DANNY | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | V. P. FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8128250891 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | IN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 200836430A | 05 | IN | MEDICAID |