Provider Demographics
NPI:1356511695
Name:MADISON FAMILY CARE, P.C
Entity Type:Organization
Organization Name:MADISON FAMILY CARE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-721-5961
Mailing Address - Street 1:8371 HIGHWAY 72 W
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9505
Mailing Address - Country:US
Mailing Address - Phone:256-721-5961
Mailing Address - Fax:256-721-7950
Practice Address - Street 1:8371 HIGHWAY 72 W
Practice Address - Street 2:SUITE 208
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9505
Practice Address - Country:US
Practice Address - Phone:256-721-5961
Practice Address - Fax:256-721-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL78870261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1114977931OtherNPI
AL1790979946OtherNPI