Provider Demographics
NPI:1134533425
Name:MADIX MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:MADIX MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-377-1984
Mailing Address - Street 1:1608 N STOCKTON HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4142
Mailing Address - Country:US
Mailing Address - Phone:928-377-1984
Mailing Address - Fax:928-377-1983
Practice Address - Street 1:1608 N STOCKTON HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4142
Practice Address - Country:US
Practice Address - Phone:928-377-1984
Practice Address - Fax:928-377-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty