Provider Demographics
NPI:1215081351
Name:MONROE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:MONROE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DYRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANVALKENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-539-7356
Mailing Address - Street 1:20 OVERBROOK DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-3101
Mailing Address - Country:US
Mailing Address - Phone:513-539-7356
Mailing Address - Fax:513-539-7782
Practice Address - Street 1:20 OVERBROOK DR
Practice Address - Street 2:UNIT C
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-3101
Practice Address - Country:US
Practice Address - Phone:513-539-7356
Practice Address - Fax:513-539-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716854Medicaid
OHMO9926341Medicare PIN