Provider Demographics
NPI:1972867141
Name:MADISON MANUAL MEDICINE, LTD.
Entity Type:Organization
Organization Name:MADISON MANUAL MEDICINE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-512-7177
Mailing Address - Street 1:1709 MONROE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2022
Mailing Address - Country:US
Mailing Address - Phone:608-512-7177
Mailing Address - Fax:608-807-5176
Practice Address - Street 1:1709 MONROE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2022
Practice Address - Country:US
Practice Address - Phone:608-512-7177
Practice Address - Fax:608-807-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE98130Medicare UPIN