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1000 Edgewood College Dr Madison WI 53711-1997 | |
| (608) 663-4861 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Edgewood College Dr, Madison, Wisconsin |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5050 Spring Valley Rd. Dallas TX 75244-3909 Ph: () - | 1000 Edgewood College Dr Madison WI 53711-1997 Ph: (608) 663-4861 |
| NPI Number | 1740739622 |
|---|---|
| Provider Enumeration Date | 10/03/2016 |
| Last Update Date | 10/03/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740739622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 64261-21 (Wisconsin) | Primary |
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