NPIMap

Organization Active NPI

Madison Medical Center

Doing business as Madison Medical Center Pharmacy

  • Long Term Care Pharmacy
  • Fredericktown, MO
National Provider Identifier
1801948880
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
003980 Issued in MO
Legal business name
MADISON MEDICAL CENTER
Doing business as
Madison Medical Center Pharmacy
Practice address
611 W Main St
Fredericktown, MO 63645-1111
Phone
(573) 783-1047
Fax
(573) 783-1063
NPI assigned
Jan 18, 2007
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Linda Hatch, RPH
Title
Pharmacy Director
Phone
(573) 783-1047

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Institutional Pharmacy 3336I0012X
Long Term Care Pharmacy 3336L0003X 003980 MO Primary

Addresses

Primary practice location

611 W Main St
Fredericktown, MO 63645-1111

Mailing address

611 W Main St
PO Box 431
Fredericktown, MO 63645-1111

Other identifiers 3

IdentifierTypeStateIssuer
010155109MedicaidMO
2050238OtherPK
601458003MedicaidMO

Other names 1

  • MADISON MEDICAL CENTER PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ajay K Upadhyay MD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1801948880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "address_2": "PO BOX 431",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-1047",
            "fax_number": "573-783-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "HATCH",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "573-783-1047",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "003980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010155109",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050238",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601458003",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON MEDICAL CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericktown, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.