Healthcare Provider Details

I. General information

NPI: 1033198981
Provider Name (Legal Business Name): SPENCER J. MADELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 5TH ST
COOKEVILLE TN
38501-1760
US

IV. Provider business mailing address

PO BOX 3262
INDIANAPOLIS IN
46206-3262
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2541
  • Fax: 931-526-8814
Mailing address:
  • Phone: 844-257-5898
  • Fax: 317-663-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31227
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: