Provider Demographics
NPI:1750815411
Name:MADISON MEDICAL LLC
Entity Type:Organization
Organization Name:MADISON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-935-2727
Mailing Address - Street 1:3010 S HARVARD AVE STE 236
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6114
Mailing Address - Country:US
Mailing Address - Phone:918-935-2727
Mailing Address - Fax:918-764-9625
Practice Address - Street 1:3010 S HARVARD AVE STE 236
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6114
Practice Address - Country:US
Practice Address - Phone:918-935-2727
Practice Address - Fax:918-764-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies