NPIMap

Organization Active NPI

Madison Ear Nose and Throat Clinic

  • Otolaryngology Physician
  • Rexburg, ID
National Provider Identifier
1265458400
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
40 Issued in ID
Legal business name
MADISON EAR NOSE AND THROAT CLINIC
Practice address
30 Madison Professional Park
Rexburg, ID 83440-2058
Phone
(208) 656-9646
Fax
(208) 656-9645
NPI assigned
Jul 14, 2006
Last updated
Jan 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debbie Sue Bulstrode
Title
Office Manager
Phone
(208) 656-9646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 40 ID Primary

Addresses

Primary practice location

30 Madison Professional Park
Rexburg, ID 83440-2058

Mailing address

30 Madison Professional Park
Rexburg, ID 83440-0828
Phone (208) 656-9646

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1265458400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400828",
            "telephone_number": "208-656-9646",
            "fax_number": "208-656-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402058",
            "telephone_number": "208-656-9646",
            "fax_number": "208-656-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON EAR NOSE AND THROAT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "BULSTRODE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-656-9646",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "ID",
            "license": "40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.