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PHYSICIAN PRACTICE OF MADISON, PC
NPI 1114476389
Specialist in Vicksburg, MS

Active since September 28, 2016
1111 N FRONTAGE RD FL 2, VICKSBURG, MS 39180(412) 721-2417(601) 510-2367 Get Directions Write a Review

NPPES record last updated: September 28, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Physician Practice Of Madison, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHYSICIAN PRACTICE OF MADISON, PC (NPI 1114476389) is a healthcare organization registered as a specialist in Vicksburg, Mississippi and active in the NPI registry since September 2016. The organization lists Shahjahan Sultan, Ceo, as its authorized official.

NPPES Registry Identity

NPI1114476389
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NamePHYSICIAN PRACTICE OF MADISON, PC
Location Address1111 N FRONTAGE RD FL 2Vicksburg, MS 39180-5102
Mailing Address6 Eastbrooke CirMadison, MS 39110-6537 · (412) 721-2417 · Fax (601) 510-2367
Phone(412) 721-2417
Fax(601) 510-2367
Organization SubpartNo
Authorized OfficialShahjahan SultanCeo · (412) 721-2417
Enumeration DateSeptember 28, 2016
✔ NPI 1114476389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MS · 21500
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1111 N FRONTAGE RD FL 2, Vicksburg, MS 39180
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Other Names 1

Doing Business AsPhysician Practice Of Madison, Pc

Other Identifiers 2

Other351416MS · Medicare Ptan
Medicaid04377714MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Physician Practice Of Madison, PC's NPI number?

The NPI number for Physician Practice Of Madison, PC is 1114476389. It was assigned to this organization in the NPPES registry on September 28, 2016.

Where is Physician Practice Of Madison, PC located?

Physician Practice Of Madison, PC is located at 1111 N Frontage Rd Fl 2, Vicksburg, MS 39180. The listed phone number is (412) 721-2417.

What is Physician Practice Of Madison, PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Physician Practice Of Madison, PC was last updated on September 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.