Basic Information
| Provider Information | |||||||||
| NPI: | 1518238740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON STREET FAMILY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 MADISON ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371603629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
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| Address1: | 1401 MADISON ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371603629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9316852022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 29483 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.