Healthcare Provider Details

I. General information

NPI: 1689635914
Provider Name (Legal Business Name): EDWARD K MADSEN PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 E 100 N STE 4
PRICE UT
84501
US

IV. Provider business mailing address

PO BOX 958
PRICE UT
84501-0958
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-7551
  • Fax: 435-636-0499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1612038905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: