Provider Demographics
NPI:1023472529
Name:MADISON WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MADISON WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-626-8833
Mailing Address - Street 1:5008 ATWOOD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8184
Mailing Address - Country:US
Mailing Address - Phone:859-626-8833
Mailing Address - Fax:859-626-8832
Practice Address - Street 1:5008 ATWOOD DR
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8184
Practice Address - Country:US
Practice Address - Phone:859-626-8833
Practice Address - Fax:859-626-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty