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General NPI Number Information
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NPI Number | 1780953596
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Entity Type | Organization
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Legal Business Name | MADISON HEALTH CENTER
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 400 CAPISTRANO DR
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City | OAKLAND
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State | CA
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Zip | 94603-3520
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Country | US
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Telephone | 510-636-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 BROADWAY SUITE 500
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City | OAKLAND
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State | CA
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Zip | 94607-4099
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Country | US
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Telephone | 510-267-8000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MUNTU R DAVIS
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Credential | M.D.
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Telephone | 510-267-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health 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 | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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