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General NPI Number Information
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NPI Number | 1720389430
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Entity Type | Organization
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Legal Business Name | MADISON COUNTY CLINIC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 946 COMMERCIAL DR UNIT 3
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City | RICHMOND
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State | KY
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Zip | 40475-3431
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Country | US
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Telephone | 859-624-0074
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Fax | 859-624-0071
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Provider Business Mailing Address
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Address Line | 2212 CARRINGTON CT
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City | LEXINGTON
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State | KY
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Zip | 40513-1234
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Country | US
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Telephone | 859-624-0074
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Fax | 859-624-0071
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SYED SHAH
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Credential | M.D
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Telephone | 606-226-8466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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