Provider Demographics
NPI:1720389430
Name:MADISON COUNTY CLINIC
Entity Type:Organization
Organization Name:MADISON COUNTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-226-8466
Mailing Address - Street 1:2212 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1234
Mailing Address - Country:US
Mailing Address - Phone:859-624-0074
Mailing Address - Fax:859-624-0071
Practice Address - Street 1:946 COMMERCIAL DR
Practice Address - Street 2:UNIT 3
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3431
Practice Address - Country:US
Practice Address - Phone:859-624-0074
Practice Address - Fax:859-624-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care