Provider Demographics
NPI:1962697284
Name:MONROE COUNTY GOVERNMENT
Entity type:Organization
Organization Name:MONROE COUNTY GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:DONCEEL
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:812-349-7344
Mailing Address - Street 1:338 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-3500
Mailing Address - Country:US
Mailing Address - Phone:812-349-7343
Mailing Address - Fax:812-349-7346
Practice Address - Street 1:338 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-3500
Practice Address - Country:US
Practice Address - Phone:812-349-7343
Practice Address - Fax:812-349-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility