Provider Demographics
NPI:1477605335
Name:MADISON HEALTH SERVICES
Entity Type:Organization
Organization Name:MADISON HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT EAST DIV.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCOPIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-538-2567
Mailing Address - Street 1:6185 PASEO DEL NORTE, STE 150
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1152
Mailing Address - Country:US
Mailing Address - Phone:855-259-2288
Mailing Address - Fax:760-918-8712
Practice Address - Street 1:5109 WORLD DAIRY DR.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-242-0220
Practice Address - Fax:608-242-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42225600Medicaid