Provider Demographics
NPI:1053482745
Name:MONARCH HEALTHCARE, A MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MONARCH HEALTHCARE, A MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-923-3205
Mailing Address - Street 1:7 TECHNOLOGY DR
Mailing Address - Street 2:4600
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3200
Mailing Address - Fax:949-923-3575
Practice Address - Street 1:7 TECHNOLOGY DR
Practice Address - Street 2:4600
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2302
Practice Address - Country:US
Practice Address - Phone:949-923-3200
Practice Address - Fax:949-923-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP21449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02999Medicare UPIN
CAI14717Medicare UPIN
CA107678Medicare UPIN
CAG32889Medicare UPIN
CAI14214Medicare UPIN
CAI24428Medicare UPIN
CAG64746Medicare UPIN
CAH79908Medicare UPIN
CAH09384Medicare UPIN
CAH79082Medicare UPIN
CAF56451Medicare UPIN
CAI16265Medicare UPIN
CAA92150Medicare UPIN
CAD80860Medicare UPIN
CAG58050Medicare UPIN
CAH32656Medicare UPIN
CAH52838Medicare UPIN
CAI10623Medicare UPIN