Provider Demographics
NPI:1235428616
Name:EDWARD MADISON III, L.L.C
Entity Type:Organization
Organization Name:EDWARD MADISON III, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:504-241-0861
Mailing Address - Street 1:9511 CHEF MENTEUR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-4231
Mailing Address - Country:US
Mailing Address - Phone:504-241-0861
Mailing Address - Fax:504-241-0850
Practice Address - Street 1:9511 CHEF MENTEUR
Practice Address - Street 2:SUITE 114
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-4231
Practice Address - Country:US
Practice Address - Phone:504-241-0861
Practice Address - Fax:504-241-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480631Medicaid
LAG64117Medicare UPIN
LA4P056Medicare PIN