Provider Demographics
NPI:1417997024
Name:SHELLEY MADSEN & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SHELLEY MADSEN & ASSOCIATES, INC.
Other - Org Name:TEXAS NUTRITION CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-250-9140
Mailing Address - Street 1:PO BOX 171235
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0042
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:5900 BALCONES DR STE 165
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4293
Practice Address - Country:US
Practice Address - Phone:512-338-4500
Practice Address - Fax:512-338-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066NROtherBLUE CROSS BLUE SHIELD
TX000W567Medicare PIN