Provider Demographics
NPI:1386727204
Name:MADISON COUNTY MEDICAL ASSOC, PC
Entity type:Organization
Organization Name:MADISON COUNTY MEDICAL ASSOC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DE REGNIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-462-1162
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-0192
Mailing Address - Country:US
Mailing Address - Phone:515-462-1162
Mailing Address - Fax:515-462-2331
Practice Address - Street 1:60 E COURT AVE
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1517
Practice Address - Country:US
Practice Address - Phone:515-462-1162
Practice Address - Fax:515-462-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269852Medicaid
IA26985OtherWELLMARK BCBS GROUP
IA26985Medicare PIN
IA0269852Medicaid