Provider Demographics
NPI:1215992698
Name:MONROE FAMILY MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:MONROE FAMILY MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DESKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-289-8427
Mailing Address - Street 1:1420 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5160
Mailing Address - Country:US
Mailing Address - Phone:704-289-8427
Mailing Address - Fax:704-283-5522
Practice Address - Street 1:1420 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-289-8427
Practice Address - Fax:704-283-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-02200Medicaid
NC02200OtherBCBS GROUP NUMBER
NC89-02200Medicaid