Provider Demographics
NPI:1508891664
Name:MEDICAL SPECIALISTS OF MADISON COUNTY, PC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF MADISON COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-643-6012
Mailing Address - Street 1:2101 JACKSON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4386
Mailing Address - Country:US
Mailing Address - Phone:765-643-6012
Mailing Address - Fax:765-646-9054
Practice Address - Street 1:2101 JACKSON ST STE 110
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4386
Practice Address - Country:US
Practice Address - Phone:765-643-6012
Practice Address - Fax:765-646-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200322260AMedicaid
IN=========002OtherBLUE CROSS
IN200322260AMedicaid