Provider Demographics
NPI:1225174006
Name:MADSEN ORTHOPEDICS, PA
Entity Type:Organization
Organization Name:MADSEN ORTHOPEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-664-0606
Mailing Address - Street 1:3009 E RENNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3571
Mailing Address - Country:US
Mailing Address - Phone:972-664-0606
Mailing Address - Fax:972-664-0808
Practice Address - Street 1:3009 E RENNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3571
Practice Address - Country:US
Practice Address - Phone:972-664-0606
Practice Address - Fax:972-664-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171291101Medicaid
TX00386XMedicare PIN