Healthcare Provider Details

I. General information

NPI: 1104127067
Provider Name (Legal Business Name): AMERICAN COMMUNITY MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 S PARK ST
MADISON WI
53715-2178
US

IV. Provider business mailing address

1421 S PARK ST
MADISON WI
53715-2178
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-6888
  • Fax: 608-441-6888
Mailing address:
  • Phone: 608-441-6888
  • Fax: 608-441-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number43432-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number434322-020
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number43432-20
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1744
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43432-20
License Number StateWI
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43432-20
License Number StateWI

VIII. Authorized Official

Name: DR. YASMIN YUSUF-SAFAVI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 608-443-9111