Healthcare Provider Details

I. General information

NPI: 1083365670
Provider Name (Legal Business Name): MADISON HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 HAMPTON WAY STE 5
RICHMOND KY
40475-8885
US

IV. Provider business mailing address

519 HAMPTON WAY STE 5
RICHMOND KY
40475-8885
US

V. Phone/Fax

Practice location:
  • Phone: 859-825-6872
  • Fax:
Mailing address:
  • Phone: 859-825-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY UNDERWOOD
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 502-529-9062