Provider Demographics
NPI:1710125505
Name:MADIX PROFESSIONAL SERVICE COMPANY
Entity Type:Organization
Organization Name:MADIX PROFESSIONAL SERVICE COMPANY
Other - Org Name:MADIX PSC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:O
Authorized Official - Middle Name:'MAT'
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-460-0295
Mailing Address - Street 1:4667 HAYGOOD RD STE 506
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5444
Mailing Address - Country:US
Mailing Address - Phone:757-460-0295
Mailing Address - Fax:
Practice Address - Street 1:4667 HAYGOOD RD STE 506
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5444
Practice Address - Country:US
Practice Address - Phone:757-460-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTIN