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General NPI Number Information
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NPI Number | 1275866048
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Entity Type | Organization
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Legal Business Name | MADSEN FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 9708 N NEVADA ST STE 203
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City | SPOKANE
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State | WA
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Zip | 99218-6004
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Country | US
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Telephone | 509-863-9240
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Fax | 509-574-5863
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Provider Business Mailing Address
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Address Line | 9708 N NEVADA ST STE 203
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City | SPOKANE
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State | WA
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Zip | 99218-6004
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Country | US
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Telephone | 509-863-9240
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CAROLYN MADSEN
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Credential |
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Telephone | 509-290-6557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00001511
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License Number State | WA
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