Provider Demographics
NPI:1427212315
Name:MADSEN ORTHOPEDICS AND SPINE, PSC
Entity Type:Organization
Organization Name:MADSEN ORTHOPEDICS AND SPINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ROBERT ERIK
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-234-2663
Mailing Address - Street 1:501 E HOSPITAL LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4230
Mailing Address - Country:US
Mailing Address - Phone:812-234-2663
Mailing Address - Fax:812-242-5878
Practice Address - Street 1:501 E HOSPITAL LN
Practice Address - Street 2:SUITE 205
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4230
Practice Address - Country:US
Practice Address - Phone:812-234-2663
Practice Address - Fax:812-242-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001875207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200920600AMedicaid
IN613979900OtherDOL FECA
IN200920600AMedicaid
IN613979900OtherDOL FECA