Provider Demographics
NPI:1285955443
Name:MADISONVILLE MEDICAL CORP.
Entity type:Organization
Organization Name:MADISONVILLE MEDICAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-845-1825
Mailing Address - Street 1:216 HWY 21
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:985-845-1825
Mailing Address - Fax:985-845-1823
Practice Address - Street 1:216 HWY 21
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-845-1825
Practice Address - Fax:985-845-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208D00000X, 363L00000X
LAM.D.011566207V00000X
LAM.D.007810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty