NPIMap

Madison Medical, PLLC

Organization Active NPI Primary Care Clinic/Center · Madison, WV

NPI 1629035449 · NPPES record last updated Jun 24, 2010

Key facts

NPI
1629035449
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
License
11402 (WV)
Legal business name
MADISON MEDICAL, PLLC
Practice address
467 Main St
Suite 200
Madison, WV 25130-2200
Phone
(304) 369-5170
Fax
(304) 369-0946
NPI assigned
Apr 26, 2006
Organization subpart
No

Authorized official

Name
Robert B Atkins, MD
Title
Dr
Phone
(304) 369-5170

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 11402 WV Yes

Addresses

Primary practice location

467 Main St
Suite 200
Madison, WV 25130-2200

Mailing address

467 Main St
Suite 200
Madison, WV 25130-2200
Phone (304) 369-5170

Other identifiers

IdentifierTypeStateIssuer
0011063000MedicaidWV

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2010.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1629035449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "467 MAIN ST",
            "address_2": "SUITE 200",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251302200",
            "telephone_number": "304-369-5170",
            "fax_number": "304-369-0946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 MAIN ST",
            "address_2": "SUITE 200",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251302200",
            "telephone_number": "304-369-5170",
            "fax_number": "304-369-0946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "ATKINS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "304-369-5170",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WV",
            "license": "11402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011063000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WV

All providers in Madison, WV · Primary Care Clinic/Center in West Virginia

Sources for this page

Verify at the official NPI Registry.