| Madison Enterprises Inc | |
|
114 N Main St Ste 102a Suffolk VA 23434-4564 | |
| (757) 921-2762 | |
| (757) 257-1011 |
| Full Name | Madison Enterprises Inc |
|---|---|
| Speciality | Counselor |
| Location | 114 N Main St Ste 102a, Suffolk, Virginia |
| Authorized Official Name and Position | Angello Madison (PRESIDENT/CEO) |
| Authorized Official Contact | 7579212762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Enterprises Inc 114 N Main St Ste 102a Suffolk VA 23434-4564 Ph: (757) 921-2762 | Madison Enterprises Inc 114 N Main St Ste 102a Suffolk VA 23434-4564 Ph: (757) 921-2762 |
| NPI Number | 1558881128 |
|---|---|
| Provider Enumeration Date | 06/23/2017 |
| Last Update Date | 03/01/2024 |
| Certification Date | 03/01/2024 |
| Medicare PECOS PAC ID | 0749627750 |
|---|---|
| Medicare Enrollment ID | O20240326004268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558881128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0701007132 (Virginia) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Angello Madison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760638043 PECOS PAC ID: 7911344924 Enrollment ID: I20240326004306 |
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