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NPI Code Detail

MEDICARE: MADISON ORTEGA

MEDICARE: MADISON ORTEGA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1508357278
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON ORTEGA
Provider Business Mailing Address
First Line : 1810 CRAIG RD STE 109
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4758
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1810 CRAIG RD STE 109
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4758
Country : US
Telephone Number : 800-780-6545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2018
Last Update Date : 05/29/2018

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Directions to “ MADISON ORTEGA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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