Provider Demographics
NPI:1639358252
Name:MADISON FAMILY HEALTH CENTER, PC
Entity Type:Organization
Organization Name:MADISON FAMILY HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-461-8442
Mailing Address - Street 1:102 ESSEX CT
Mailing Address - Street 2:STE C
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3138
Mailing Address - Country:US
Mailing Address - Phone:256-461-8442
Mailing Address - Fax:256-461-8447
Practice Address - Street 1:102 ESSEX CT
Practice Address - Street 2:STE C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3138
Practice Address - Country:US
Practice Address - Phone:256-461-8442
Practice Address - Fax:256-461-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty