Provider Demographics
NPI:1902423825
Name:MADISON FREE CLINIC, INC
Entity Type:Organization
Organization Name:MADISON FREE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:CNPP
Authorized Official - Phone:540-948-3667
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-0914
Mailing Address - Country:US
Mailing Address - Phone:540-948-3667
Mailing Address - Fax:540-948-2209
Practice Address - Street 1:410 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727
Practice Address - Country:US
Practice Address - Phone:540-948-3667
Practice Address - Fax:540-948-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care