MEDICARE: MRS. MARCIA ANN MADISON

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1619570082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA ANN MADISON

Provider Business Mailing Address
First Line	:	452 EL CENTRO DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-6122
Country	:	US
Telephone Number	:	419-450-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 EL CENTRO DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-6122
Country	:	US
Telephone Number	:	419-450-7683
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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