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NPI Code Detail

MEDICARE: MADISON EAST INTERNAL MEDICINE LLC

MEDICARE: MADISON EAST INTERNAL MEDICINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295958155
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON EAST INTERNAL MEDICINE LLC
Provider Business Mailing Address
First Line : PO BOX 648
Second Line :
City : HOUSTON
State : MS
Zip : 38851-0648
Country : US
Telephone Number : 662-448-6213
Fax Number : 662-448-6215
Provider Business Practice Location Address
First Line : 1002 E MADISON ST
Second Line :
City : HOUSTON
State : MS
Zip : 38851-2417
Country : US
Telephone Number : 662-448-6213
Fax Number : 662-448-6215
Authorized Official
Title or Position : PHYSICIAN
Name : NOEL VILLAROSA GARCIA
Credential : MD
Telephone Number : 662-448-6213
Provider Enumeration Date : 04/10/2007
Last Update Date : 11/12/2009

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Directions to “MADISON EAST INTERNAL MEDICINE LLC ” Practice Location

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