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MEDICAL OUTREACH SERVICES OF MADISON PC NPI 1972975886


NPI Information

NPI: 1972975886
Provider Name: MEDICAL OUTREACH SERVICES OF MADISON PC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 11D2107161

Address:
1075 S MAIN ST
SUITE 400
MADISON, GA
ZIP 30650
Phone: (706) 342-9664
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MEDICAL OUTREACH SERVICES OF MADISON PC is an internal medicine in Madison, GA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. MEDICAL OUTREACH SERVICES OF MADISON PC NPI is 1972975886. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1075 S MAIN ST
SUITE 400
MADISON, GA
ZIP 30650-033
Phone: (706) 342-9664

The provider's authorized official is Miguel Eduardo Cossio .
The authorized official title is P and has the following contact phone number (706) 342-9664.

The CLIA number assigned to this NPI record is 11D2107161 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/30/2015 and was last updated on 10/30/2015.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineGEORGIAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP7517MEDICARE UPINGEORGIA
2000289517AMEDICAIDGEORGIA

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: 5/5/2024

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