Provider Demographics
NPI:1407086101
Name:MADISON FAMILY PRACTICE
Entity Type:Organization
Organization Name:MADISON FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:731-660-6402
Mailing Address - Street 1:621 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2907
Mailing Address - Country:US
Mailing Address - Phone:731-660-6402
Mailing Address - Fax:731-660-6402
Practice Address - Street 1:621 OLD HICKORY BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2907
Practice Address - Country:US
Practice Address - Phone:731-660-6402
Practice Address - Fax:731-660-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty