Provider Demographics
NPI:1245442318
Name:MADISON FAMILY HEALTH CORPORATION
Entity type:Organization
Organization Name:MADISON FAMILY HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-845-7015
Mailing Address - Street 1:P.O. BOX 638816
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8816
Mailing Address - Country:US
Mailing Address - Phone:614-293-2100
Mailing Address - Fax:614-293-3606
Practice Address - Street 1:210 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1115
Practice Address - Country:US
Practice Address - Phone:740-845-7518
Practice Address - Fax:740-845-7045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON FAMILY HEALTH CORPORATION DBA MADISON HEALTH SPECIALTY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
OH207Q00000X, 2084N0400X, 208800000X, 208600000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2807421Medicaid
OH2807421Medicaid