Provider Demographics
NPI:1992863229
Name:MADISON MEDICAL ASSOCIATES PSC
Entity Type:Organization
Organization Name:MADISON MEDICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-3837
Mailing Address - Street 1:793 EASTERN BYP
Mailing Address - Street 2:SUITE #206
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-623-3837
Mailing Address - Fax:859-623-3992
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:SUITE #206
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:859-623-3837
Practice Address - Fax:859-623-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21619207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904666Medicaid
KYC10106OtherFEDERAL BLACK LUNG
KYC10106OtherFEDERAL BLACK LUNG
KY65904666Medicaid