| Medical Outreach Services Of Madison Pc | |
|
1075 S Main St Suite 400 Madison GA 30650-2033 | |
| (706) 342-9664 | |
| Not Available |
| Full Name | Medical Outreach Services Of Madison Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1075 S Main St, Madison, Georgia |
| Authorized Official Name and Position | Miguel Eduardo Cossio (P) |
| Authorized Official Contact | 7063429664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Outreach Services Of Madison Pc 1075 S Main St Suite 400 Madison GA 30650-2033 Ph: (706) 342-9664 | Medical Outreach Services Of Madison Pc 1075 S Main St Suite 400 Madison GA 30650-2033 Ph: (706) 342-9664 |
| NPI Number | 1972975886 |
|---|---|
| Provider Enumeration Date | 10/30/2015 |
| Last Update Date | 10/30/2015 |
| Medicare PECOS PAC ID | 6507150760 |
|---|---|
| Medicare Enrollment ID | O20160810002039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972975886 | NPI | - | NPPES |
| 000289517A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Georgia) | Primary |
| Provider Name | Miguel E Cossio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669426557 PECOS PAC ID: 1850312166 Enrollment ID: I20051214000808 |
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