LK Madison MD LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

33436 Issued in IA

Legal business name

LK MADISON MD LLC

Practice address

417 S East St
Corydon, IA 50060-1860

Phone

(641) 872-2260

Fax

(641) 872-3656

NPI assigned

Sep 17, 2012

Last updated

Sep 17, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Louis Keith Madison, M.D.

Title

Sole Member/Owner/Physician

Phone

(641) 872-2260

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1447500418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503125305",
            "telephone_number": "515-237-3974",
            "fax_number": "515-883-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S EAST ST",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500601860",
            "telephone_number": "641-872-2260",
            "fax_number": "641-872-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LK MADISON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "MADISON",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "SOLE MEMBER/OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "641-872-2260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "33436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IN PROCESS",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.