NPI 1740739622

Edgewood College, INC

Organisation Family Medicine Physician Madison, WI

Practice location

Address: 1000 Edgewood College Dr, Madison, WI 53711-1997
Phone: (608) 663-4861
Mailing address: 5050 Spring Valley Rd., Dallas, TX 75244-3909

Authorised official

Name: Mouzon Bass
Title: Agent
Phone: (972) 367-4845

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence 64261-21 (WI)

Other Family Medicine providers in Wisconsin →

Registry record

NPI: 1740739622
Entity type: Organization
NPI issued: 3 Oct 2016
Record last updated: 3 Oct 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.