Basic Information
| Provider Information | |||||||||
| NPI: | 1629035449 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 467 MAIN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MADISON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251302200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043695170 | ||||||||
| FaxNumber: | 3043690946 | ||||||||
| Practice Location | |||||||||
| Address1: | 467 MAIN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MADISON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251302200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043695170 | ||||||||
| FaxNumber: | 3043690946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | ATKINS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DR | ||||||||
| AuthorizedOfficialTelephone: | 3043695170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 11402 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0011063000 | 05 | WV | MEDICAID |