Madison Memorial Hospital

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

MADISON MEMORIAL HOSPITAL

Practice address

450 E Main St
Rexburg, ID 83440-2048

Phone

(208) 359-6900

NPI assigned

Nov 7, 2012

Last updated

Nov 7, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

MADISON MEMORIAL HOSPITALAs reported in NPPES

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

Authorized official

Name

Dorsie Sullenger, RPHNPI 1831682194

Title

Director of Pharmacy

Phone

(208) 359-6900

Specialties & licenses 1

Addresses

Part of

Madison Memorial Hospital

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.

• Madison Co Memorial Hospital

  • General Acute Care Hospital
  • Rexburg, ID
  • NPI 1992747570
  NPPES parent name

Practitioners 1

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.

• Dorsie Thomas Sullenger

  • Pharmacist
  • Rexburg, ID
  • NPI 1831682194
  Authorized official Same address or phone

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1821342247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443248",
            "telephone_number": "952-653-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402048",
            "telephone_number": "208-359-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON MEMORIAL HOSPITAL",
        "enumeration_date": "2012-11-07",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "SULLENGER",
        "authorized_official_first_name": "DORSIE",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "208-359-6900",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Co Memorial Hospital
• Madison Ear Nose and Throat Clinic
• Madison Foot & Ankle Care, PA
• Madison General Surgery Clinic
• Madison Memorial Hospital (Madison Clinic Physicians)
• Madison Park Dental Center
• Madison Park Dental Center PLLC
• Madison Physician Services
• Madison Ridge Chiropractic
• Madison Women's Clinic

• Non-Pharmacy Dispensing Site in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Non-Pharmacy Dispensing Site in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.