Provider Demographics
NPI:1629035449
Name:MADISON MEDICAL, PLLC
Entity Type:Organization
Organization Name:MADISON MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-369-5170
Mailing Address - Street 1:467 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-2200
Mailing Address - Country:US
Mailing Address - Phone:304-369-5170
Mailing Address - Fax:304-369-0946
Practice Address - Street 1:467 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-2200
Practice Address - Country:US
Practice Address - Phone:304-369-5170
Practice Address - Fax:304-369-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11402261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011063000Medicaid
9237411Medicare PIN
WVW43457Medicare UPIN