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PHYSICIAN PRACTICE OF MADISON PC NPI 1114476389


NPI Information

NPI: 1114476389
Provider Name: PHYSICIAN PRACTICE OF MADISON, PC

Doing Business As: PHYSICIAN PRACTICE OF MADISON, PC

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
1111 N FRONTAGE RD FL 2
VICKSBURG, MS
ZIP 39180
Phone: (412) 721-2417
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PHYSICIAN PRACTICE OF MADISON, PC is a specialist in Vicksburg, MS. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PHYSICIAN PRACTICE OF MADISON, PC NPI is 1114476389. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Physician Practice Of Madison, Pc.

The provider's business location address is:

1111 N FRONTAGE RD FL 2
VICKSBURG, MS
ZIP 39180-102
Phone: (412) 721-2417
Fax: (601) 510-2367

The provider's authorized official is Shahjahan Sultan .
The authorized official title is Ceo and has the following contact phone number (412) 721-2417.

The enumeration date for this NPI number is 9/28/2016 and was last updated on 9/28/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist21500MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1351416OTHERMISSISSIPPIMEDICARE PTAN
204377714MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.