MEDICARE: MADISON MEDICAL 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750815411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON MEDICAL LLC

Provider Business Mailing Address
First Line	:	3020 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6138
Country	:	US
Telephone Number	:	918-935-2727
Fax Number	:	918-764-9625

Provider Business Practice Location Address
First Line	:	3020 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6138
Country	:	US
Telephone Number	:	918-935-2727
Fax Number	:	918-764-9625

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM LANCE MADISON
Credential	:
Telephone Number	:	918-935-2727

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	04/01/2025

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