Provider Demographics
NPI:1215281217
Name:MONROE COMMUNITY CLINIC
Entity type:Organization
Organization Name:MONROE COMMUNITY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:FORESTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-563-5007
Mailing Address - Street 1:4101 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5611
Mailing Address - Country:US
Mailing Address - Phone:704-563-5007
Mailing Address - Fax:704-563-5070
Practice Address - Street 1:4101 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5611
Practice Address - Country:US
Practice Address - Phone:704-563-5007
Practice Address - Fax:704-563-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care