NPIMap

Organization Active NPI

Madison Co Memorial Hospital

Doing business as Madison Memorial Outpatient Services

  • Physiological Laboratory
  • Rexburg, ID
National Provider Identifier
1316460264
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MADISON CO MEMORIAL HOSPITAL
Doing business as
Madison Memorial Outpatient Services
Practice address
255 N 3Rd E Ste 200
Rexburg, ID 83440-1629
Phone
(208) 359-6516
NPI assigned
Jul 24, 2017
Last updated
Mar 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MADISON CO MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Troy Christensen
Title
Chief Financial Officer
Phone
(208) 359-9802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X NU Primary

Addresses

Primary practice location

255 N 3Rd E Ste 200
Rexburg, ID 83440-1629

Mailing address

PO Box 700
Rexburg, ID 83440-0700
Phone (208) 359-6516

Other names 1

  • Madison Memorial Outpatient Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000664 ID Part B Supplier - Clinic/Group Practice 8123016367 Receives reassigned benefits from 45 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rexburg, ID; Rigby, ID

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Madison Co Memorial Hosp5 organizations share this tax ID, including this one
Part of
Madison Co Memorial Hosp

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

255 N 3rd E
Ste 200
Rexburg, ID 83440
Phone (208) 359-6516

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1500854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1316460264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400700",
            "telephone_number": "208-359-6516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N 3RD E STE 200",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401629",
            "telephone_number": "208-359-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON CO MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON CO MEMORIAL HOSPITAL",
        "enumeration_date": "2017-07-24",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "208-359-9802"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Memorial Outpatient Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Madison Memorial Outpatient Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.