Provider Demographics
NPI:1730730979
Name:MONARCH MEDICAL MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:MONARCH MEDICAL MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETIPRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-550-8828
Mailing Address - Street 1:PO BOX 201652
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BLDG 3, SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:512-550-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty