Provider Demographics
NPI:1376784603
Name:MADISON CONSOLIDATED SCHOOL
Entity Type:Organization
Organization Name:MADISON CONSOLIDATED SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-265-2720
Mailing Address - Street 1:2421 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2134
Mailing Address - Country:US
Mailing Address - Phone:812-265-2720
Mailing Address - Fax:812-265-6569
Practice Address - Street 1:2421 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2134
Practice Address - Country:US
Practice Address - Phone:812-265-2720
Practice Address - Fax:812-265-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100471840Medicaid