Madison Avenue Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MADISON AVENUE SURGERY CENTER LLC

Practice address

3760 Washington Pkwy
Idaho Falls, ID 83404-7593

Phone

(208) 881-5351

NPI assigned

Dec 16, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Mark Edward Freeman, MD

Title

President

Phone

(208) 881-5351

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450224000000",
    "number": "1396100491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047593",
            "telephone_number": "208-881-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047593",
            "telephone_number": "208-881-5351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON AVENUE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-881-5351",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis C Macieski, CRNA
• Megan Michelle Macneil
• Analiese Madder
• Katie Diane Maddock
• Madison Avenue Surgery Center LLC
• Catherine Jaylinn Madrid
• Jessica Magner
• Magno C. Santos MSN, FNP-C PLLC
• Magno C. Santos MSN, FNP-C PLLC
• Magno C. Santos MSN, FNP-C PLLC

• Ambulatory Surgical Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.