NPIMap

Organization Active NPI

The Madison Center

  • Speech-Language Pathologist
  • Excelsior, MN
National Provider Identifier
1083832158
Registry record updated Jan 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
THE MADISON CENTER
Practice address
464 2ND St Ste 106
Excelsior, MN 55331-2108
Phone
(952) 401-4242
Fax
(952) 401-4285
NPI assigned
Apr 23, 2007
Last updated
Jan 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tracy A Dolliff
Title
President
Phone
(952) 401-4242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

464 2ND St Ste 106
Excelsior, MN 55331-2108

Mailing address

4200 Mount Curv
Excelsior, MN 55331-9262
Phone (952) 401-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160511001287 MN Part B Supplier - Clinic/Group Practice 5092004200 Receives reassigned benefits from 3 practitioners
Practice locations: Excelsior, MN

National Provider Directory

National Provider Directory

Locations

464 2nd St
Ste 106
Excelsior, MN 55331
Phone (952) 401-4200

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264723200000",
    "number": "1083832158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 MOUNT CURV",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553319262",
            "telephone_number": "952-401-4242",
            "fax_number": "952-401-4285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 2ND ST STE 106",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553312108",
            "telephone_number": "952-401-4242",
            "fax_number": "952-401-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MADISON CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2010-01-29",
        "status": "A",
        "authorized_official_last_name": "DOLLIFF",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-401-4242",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.