Provider Demographics
NPI:1578636767
Name:MADISON SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MADISON SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:VEERAYYA
Authorized Official - Last Name:MAILAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-265-1890
Mailing Address - Street 1:207 LONGWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5243
Mailing Address - Country:US
Mailing Address - Phone:256-265-1890
Mailing Address - Fax:256-265-1891
Practice Address - Street 1:207 LONGWOOD DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5243
Practice Address - Country:US
Practice Address - Phone:256-265-1890
Practice Address - Fax:256-265-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26102208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HH66524Medicare UPIN