=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467101691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON RYCE ENDICOTT DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2022
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 JOHN LLOYD EVANS MEMORIAL DR STE 200
-----------------------------------------------------
City | NELSONVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45764-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-753-7323
-----------------------------------------------------
Fax | 740-753-7388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7527
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43017-0727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 58.032825
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------