| Family Service Madison Inc | |
|
128 E Olin Ave Suite 100 Madison WI 53713-1467 | |
| (608) 316-1186 | |
| (608) 252-1333 |
| Full Name | Family Service Madison Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 128 E Olin Ave, Madison, Wisconsin |
| Authorized Official Name and Position | Brigid Okeefe (CREDENTIAL COORDINATOR) |
| Authorized Official Contact | 6083161186 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Service Madison Inc 128 E Olin Ave Suite 100 Madison WI 53713-1467 Ph: (608) 316-1186 | Family Service Madison Inc 128 E Olin Ave Suite 100 Madison WI 53713-1467 Ph: (608) 316-1186 |
| NPI Number | 1881806198 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 5799760476 |
|---|---|
| Medicare Enrollment ID | O20040618000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881806198 | NPI | - | NPPES |
| 43006500 | Medicaid | WI | |
| 42106700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Wisconsin) | Primary |
| Provider Name | Greg W Chism |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972662013 PECOS PAC ID: 8820147598 Enrollment ID: I20090529000144 |
| Provider Name | Marcus R Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467591263 PECOS PAC ID: 2365592706 Enrollment ID: I20090605000549 |
| Provider Name | Teri Jo Varney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932248739 PECOS PAC ID: 9335286350 Enrollment ID: I20091023000635 |
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