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General NPI Number Information
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NPI Number | 1366772725
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Entity Type | Organization
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Legal Business Name | MADISON SPECIALTY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 2580 MICHIGAN RD
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City | MADISON
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State | IN
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Zip | 47250-2491
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Country | US
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Telephone | 812-265-5800
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Fax | 812-265-5864
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Provider Business Mailing Address
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Address Line | PO BOX 816
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City | MADISON
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State | IN
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Zip | 47250-0816
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Country | US
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Telephone | 812-265-5800
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Fax | 812-265-5864
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. AMBER NORRIS
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Credential | LPN
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Telephone | 812-265-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 01028535A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01028535A
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License Number State | IN
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