MADISON MEMORIAL HOSPITAL (NPI# 1346643038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346643038 |
| Entity Type | Organization |
| Organization Name | MADISON MEMORIAL HOSPITAL |
| Other Organization Name | MADISON CLINIC PHYSICIANS |
| Practice Address |
450 E Main St Rexburg ID 83440-2048 |
| Mailing Address |
Po Box 130 Rexburg ID 83440-0130 |
| Practice Telephone | 2083596419 |
| Practice Fax Number | 2083596915 |
| Mailing Telephone | 2083596419 |
| Mailing Fax Number | 2083596915 |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2020-04-02 |
| Authorized Official Name | TROY CHRISTENSEN (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2083599802 |
| Is Organization Subpart | Y |
| Parent Organization Name | MADISON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
40 | ID | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Madison Clinic Physicians | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821342247 | Madison Memorial Hospital | Non-Pharmacy Dispensing Site | 450 E Main St, Rexburg, ID 83440-2048 | 2012-11-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MADISON MEMORIAL HOSPITAL | 450 E Main St, Rexburg, ID 83440-2048 |
| Street Address |
450 E MAIN ST |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1396352142 | Karissa Thueson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2020-09-25 |
| 1376192674 | David Howard Anderson | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2019-09-09 |
| 1124676663 | Susan B Clark | Dietitian, Registered | 450 E Main St, Rexburg, ID 83440-2048 | 2019-08-28 |
| 1790278760 | Allen Terry Miller | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-13 |
| 1831682194 | Dorsie Thomas Sullenger | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-12 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1215471065 | Troy Hanson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2016-12-13 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| 1871941724 | Justin Shippen | Family Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2016-06-01 |
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|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285700377 | Rexburg Family Medical Center, Pllc | Clinic/Center | 1 Professional Plz, Rexburg, ID 83440-2024 | 2006-11-28 |
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| 1275186835 | Bella Family Healthcare & Aesthetics | Clinic/Center | 1545 E Leighfield Dr Ste 100, Meridian, ID 83646-5371 | 2019-07-22 |
| 1902387285 | Integrative Health Solutions Pllc | Clinic/Center | 1215 Michigan St Ste B, Sandpoint, ID 83864-5014 | 2018-08-24 |
| 1235618331 | Healthworks Med Group of Colorado P C | Clinic/Center | 126 E 21st St, Burley, ID 83318-2551 | 2018-08-09 |
| 1427537927 | Gem State Family Health Care Pllc | Clinic/Center | 496 Shoup Ave W Ste E, Twin Falls, ID 83301-5043 | 2018-08-07 |
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1073031118 | Clover Creek Medical | Clinic/Center | 175 North Main Street, Bloomington, ID 83223-8322 | 2017-09-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.