Healthcare Provider Details

I. General information

NPI: 1124202676
Provider Name (Legal Business Name): MADISON SURGICAL APPLIANCE CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 MILWAUKEE ST STE 2&3
MADISON WI
53714-3508
US

IV. Provider business mailing address

4222 MILWAUKEE ST STE 2&3
MADISON WI
53714-3508
US

V. Phone/Fax

Practice location:
  • Phone: 608-241-7170
  • Fax: 608-241-7190
Mailing address:
  • Phone: 608-241-7170
  • Fax: 608-241-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEWELL A HUGHES
Title or Position: OWNER
Credential: CERTIFIED FITTER
Phone: 608-241-7170