Provider Demographics
NPI:1235416207
Name:MADISON MEDICAL LLC
Entity Type:Organization
Organization Name:MADISON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:918-642-5310
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-0187
Mailing Address - Country:US
Mailing Address - Phone:918-642-5310
Mailing Address - Fax:918-642-3690
Practice Address - Street 1:1047 E MAIN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2839
Practice Address - Country:US
Practice Address - Phone:918-225-1033
Practice Address - Fax:918-225-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8-D-3007332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies