Provider Demographics
NPI:1891382057
Name:MADISON HEALTHCARE AND WELLNESS CTR. PC
Entity type:Organization
Organization Name:MADISON HEALTHCARE AND WELLNESS CTR. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-274-0713
Mailing Address - Street 1:220 CLIFTY DR STE J
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1669
Mailing Address - Country:US
Mailing Address - Phone:812-274-0713
Mailing Address - Fax:812-205-2970
Practice Address - Street 1:220 CLIFTY DR STE J
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1669
Practice Address - Country:US
Practice Address - Phone:812-274-0713
Practice Address - Fax:812-205-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty