Provider Demographics
NPI:1285415216
Name:LD-MADISON, LLC
Entity type:Organization
Organization Name:LD-MADISON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:256-783-9468
Mailing Address - Street 1:306 FOUNTAINS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6384
Mailing Address - Country:US
Mailing Address - Phone:601-605-1410
Mailing Address - Fax:601-605-1367
Practice Address - Street 1:306 FOUNTAINS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6384
Practice Address - Country:US
Practice Address - Phone:601-605-1410
Practice Address - Fax:601-605-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental