Provider Demographics
NPI:1124202676
Name:MADISON SURGICAL APPLIANCE CENTRE
Entity Type:Organization
Organization Name:MADISON SURGICAL APPLIANCE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FITTER
Authorized Official - Phone:608-241-7170
Mailing Address - Street 1:4222 MILWAUKEE ST STE 2&3
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3508
Mailing Address - Country:US
Mailing Address - Phone:608-241-7170
Mailing Address - Fax:608-241-7190
Practice Address - Street 1:4222 MILWAUKEE ST STE 2&3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3508
Practice Address - Country:US
Practice Address - Phone:608-241-7170
Practice Address - Fax:608-241-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI417249000Medicaid
WI3923500001Medicare NSC