MADISON CO MEMORIAL HOSPITAL (NPI# 1538101100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538101100 |
| Entity Type | Organization |
| Organization Name | MADISON CO MEMORIAL HOSPITAL |
| Practice Address |
36 Professional Plz Suite 102 Rexburg ID 83440-2049 |
| Mailing Address |
Po Box 700 Rexburg ID 83440-0700 |
| Practice Telephone | 2083599888 |
| Practice Fax Number | 2083596747 |
| Mailing Telephone | 2083563691 |
| Mailing Fax Number | 2083596764 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2009-10-12 |
| Authorized Official Name | GREGORY D HEXEM (CFO) |
| Authorized Official Telephone | 2083599802 |
| Is Organization Subpart | Y |
| Parent Organization Name | MADISON CO MEMORIAL HOSPITAL |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 40 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | REGENCE BLUE SHIELD OF ID | 000010006289 | 01 |
| ID | 807097400 | 05 | |
| ID | BLUE CROSS OF IDAHO | 8K339 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992747570 | Madison Co Memorial Hospital | General Acute Care Hospital | 450 E. Main, Rexburg, ID 83440 | 2006-06-11 |
| 1073154266 | Madison Co Memorial Hospital | Pediatrics | 37 S 2nd E, Rexburg, ID 83440-1906 | 2019-09-30 |
| 1316460264 | Madison Co Memorial Hospital | General Practice | 393 E 2nd N, Rexburg, ID 83440-1605 | 2017-07-24 |
| 1730602756 | Madison Co Memorial Hospital | Orthopaedic Surgery | 393 E 2nd N, Rexburg, ID 83440-1605 | 2017-07-21 |
| 1134592017 | Madison Co Memorial Hospital | Family Medicine | 393 E 2nd N, Rexburg, ID 83440-1605 | 2015-11-02 |
| 1710294335 | Madison Co Memorial Hospital | Hospitalist | 450 E Main St, Rexburg, ID 83440-2048 | 2010-09-02 |
| Street Address |
36 PROFESSIONAL PLZ SUITE 102 |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700822491 | Rodney Bates Jr. | Internal Medicine | 36 Professional Plz, Rexburg, ID 83440-2049 | 2006-06-21 |
| 1538663927 | Tiffany L Love | Counselor | 36 Professional Plz, Rexburg, ID 83440 | 2018-03-20 |
| 1316484983 | Mhd Therapies, Pllc | Occupational Therapist | 36 Professional Plz, Ste 110, Rexburg, ID 83440-2049 | 2017-01-20 |
| 1760831549 | Tyler Harrigfeld | Physical Therapist | 36 Professional Plz, Rexburg, ID 83440-2049 | 2016-06-13 |
| 1114297660 | Janiel J Green | Physician Assistant | 36 Professional Plz, Suite #102, Rexburg, ID 83440-2049 | 2011-12-30 |
| 1558662064 | Linda R Webster | Nurse Practitioner | 36 Professional Plz, Rexburg, ID 83440-2049 | 2010-11-15 |
| 1518196021 | Jason Ern Hymas | Pediatrics | 36 Professional Plz, Suite 202, Rexburg, ID 83440-2049 | 2009-07-06 |
| 1578714770 | Generations Women's Clinic, Pllc | Obstetrics & Gynecology | 36 Professional Plz, Rexburg, ID 83440-2049 | 2008-10-06 |
| 1215108766 | Andrew Summers Dds, Ms, PC | Dentist | 36 Professional Plz, Suite 200, Rexburg, ID 83440-2049 | 2008-03-12 |
| 1033394713 | Northridge Internal Medicine, Pllc | Internal Medicine | 36 Professional Plz, Ste-102, Rexburg, ID 83440-2049 | 2007-12-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205918620 | Craig D Heiner | Internal Medicine | 240 East Main, Rexburg, ID 83440 | 2006-10-19 |
| 1700822491 | Rodney Bates Jr. | Internal Medicine | 36 Professional Plz, Rexburg, ID 83440-2049 | 2006-06-21 |
| 1558348649 | Hans Thurgood Redd | Internal Medicine | 100 Shc, Rexburg, ID 83460-2010 | 2005-12-29 |
| 1033394713 | Northridge Internal Medicine, Pllc | Internal Medicine | 36 Professional Plz, Ste-102, Rexburg, ID 83440-2049 | 2007-12-31 |
| 1154524734 | Steven Hansen Lofgran | Internal Medicine | 37 S 2nd E, Rexburg, ID 83440 | 2007-06-09 |
| 1174699722 | Seasons Medical, Pllc | Internal Medicine | 37 S 2nd E, Rexburg, ID 83440 | 2006-11-27 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891256004 | Ryan Thompson | Internal Medicine | 400 W Fort St # 111r, Boise, ID 83702-4531 | 2019-03-29 |
| 1306385950 | Basis Internal Medicine | Internal Medicine | 723 W Headwaters Dr, Eagle, ID 83616-5749 | 2017-02-15 |
| 1518311679 | Samantha Hersrud | Internal Medicine | 500 W Fort St 111r, Internal Medicine Residency, Boise, ID 83702 | 2016-04-14 |
| 1649634718 | Elizabeth Ann Schackmann | Internal Medicine | 500 W Fort St # 111r, Boise, ID 83702-4501 | 2016-04-05 |
| 1003278730 | Tyler T Birch | Internal Medicine | 520 S Eagle Rd Ste 3102, Meridian, ID 83642-6352 | 2016-03-22 |
| 1134513088 | Alex Tanabe | Internal Medicine | 1000 E Park Blvd, Boise, ID 83712-7791 | 2015-03-27 |
| 1932512811 | Cory Spicer | Internal Medicine | 2265 E Sunnyside Rd, Idaho Falls, ID 83404-7598 | 2014-06-09 |
| 1598196784 | Gabriela Anghel | Internal Medicine | 500 S 11th Ave Ste 303, Pocatello, ID 83201-4879 | 2013-12-12 |
| 1871934547 | Ian Zafar Qureshi | Internal Medicine | 4400 E Flamingo Ave Ste 130, Nampa, ID 83687 | 2013-07-10 |
| 1386083764 | Avery Jeffers | Internal Medicine | 44 N. 1st E., Attn: Colleen Jensen, Preston, ID 83263-1326 | 2013-06-19 |
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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.