Provider Demographics
NPI:1588837264
Name:MADISON MINOR EMERG CTR
Entity Type:Organization
Organization Name:MADISON MINOR EMERG CTR
Other - Org Name:MADISON MINOR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:BARR
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-868-9959
Mailing Address - Street 1:1210 BRIARVILLE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5136
Mailing Address - Country:US
Mailing Address - Phone:615-868-9959
Mailing Address - Fax:615-865-1463
Practice Address - Street 1:1114 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-868-9959
Practice Address - Fax:615-865-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8280261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3185053Medicare PIN