Provider Demographics
NPI:1942445994
Name:MADISON KIDNEY CLINIC
Entity Type:Organization
Organization Name:MADISON KIDNEY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-668-4337
Mailing Address - Street 1:16 MURRAY GUARD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3750
Mailing Address - Country:US
Mailing Address - Phone:731-668-4337
Mailing Address - Fax:731-661-0124
Practice Address - Street 1:16 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3750
Practice Address - Country:US
Practice Address - Phone:731-668-4337
Practice Address - Fax:731-661-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty