Organization Name: | MADISON HIGH SBHC |
NPI Number: | 1619098498 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SYLVIA FARRISH REDD (APNP) |
Mailing Address: | 301 S. Chestnut Tallulah |
State: | LA US |
Postal Code: | 71282 |
Phone Number: | 3185745371 |
Fax Number: | 3185745345 |
NPI Enumeration Date: | 04/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Student Health |
Taxonomy Definition: |