MEDICARE: MADISON FORD

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1518735851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON FORD

Provider Business Mailing Address
First Line	:	24253 ALYDAR LOOP
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36526-0330
Country	:	US
Telephone Number	:	251-235-2531
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 COTTAGE HILL RD STE 400
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-2913
Country	:	US
Telephone Number	:	251-235-2531
Fax Number	:	833-997-2206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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Directions to “ MADISON FORD ” Practice Location

Language	Start Address	Practice Location

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