Provider Demographics
NPI:1538355482
Name:MONROE PHYSICIANS GROUP
Entity type:Organization
Organization Name:MONROE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-825-1111
Mailing Address - Street 1:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1424
Mailing Address - Country:US
Mailing Address - Phone:317-802-3152
Mailing Address - Fax:
Practice Address - Street 1:4011 S TIWARI BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8000
Practice Address - Country:US
Practice Address - Phone:812-825-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty