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NPI Code Detail

MEDICARE: MS. MARY ELIZABETH MADILL P.A.

MEDICARE: MS. MARY ELIZABETH MADILL P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1366636821
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELIZABETH MADILL P.A.
Provider Business Mailing Address
First Line : 38 WESTGATE ST
Second Line :
City : SEARCY
State : AR
Zip : 72143-4915
Country : US
Telephone Number : 501-593-0921
Fax Number : 479-495-6290
Provider Business Practice Location Address
First Line : 901 E BEEBE CAPPS EXPY
Second Line :
City : SEARCY
State : AR
Zip : 72143-6865
Country : US
Telephone Number : 501-203-0801
Fax Number : 501-203-0802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2007
Last Update Date : 01/03/2020

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