Provider Demographics
NPI:1295978559
Name:MADISON FAMILY PRACTICE ASSOCIATES. PC
Entity type:Organization
Organization Name:MADISON FAMILY PRACTICE ASSOCIATES. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-430-0030
Mailing Address - Street 1:8371 HWY 72 WEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-430-0030
Mailing Address - Fax:256-721-0408
Practice Address - Street 1:8371 HWY 72 WEST
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-430-0030
Practice Address - Fax:256-721-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-19621OtherBLUE CROSS
AL000019621Medicare Oscar/Certification
ALC72765Medicare UPIN