Provider Demographics
NPI:1710085915
Name:MADISON ADULT MEDICINE, INC.
Entity Type:Organization
Organization Name:MADISON ADULT MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-868-0600
Mailing Address - Street 1:607 W DUE WEST AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4431
Mailing Address - Country:US
Mailing Address - Phone:615-868-0600
Mailing Address - Fax:615-868-9544
Practice Address - Street 1:607 W DUE WEST AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4431
Practice Address - Country:US
Practice Address - Phone:615-868-0600
Practice Address - Fax:615-868-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802837Medicaid
TN3802837Medicaid
TNG28855Medicare UPIN