Healthcare Provider Details

I. General information

NPI: 1134592694
Provider Name (Legal Business Name): JEFFREY W. MADSEN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

560 W 800 N
OREM UT
84057-3746
US

V. Phone/Fax

Practice location:
  • Phone: 435-627-4800
  • Fax:
Mailing address:
  • Phone: 801-225-6246
  • Fax: 801-225-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number333118-1205
License Number StateUT

VIII. Authorized Official

Name: JANELL BURGON
Title or Position: CREDENTIALING
Credential:
Phone: 801-701-6504