NPIMap

Organization Active NPI

Madison Community Hospital Inc

  • Community/Retail Pharmacy
  • Warren, MI
National Provider Identifier
1962664060
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008844 Issued in MI
Legal business name
MADISON COMMUNITY HOSPITAL INC
Practice address
4050 E 12 Mile Rd
Warren, MI 48092-2534
Phone
(586) 578-0220
Fax
(586) 578-0225
NPI assigned
Jun 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Ryan Gunabalan
Title
Owner
Phone
(248) 792-1746

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008844 MI Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

4050 E 12 Mile Rd
Warren, MI 48092-2534

Mailing address

4050 E 12 Mile Rd
Warren, MI 48092-2534
Phone (586) 578-0220

Other identifiers 2

IdentifierTypeStateIssuer
2807858MedicaidMI
2043722OtherPK

Other names 1

  • BC OF MICHIGAN PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Madison Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1962664060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922534",
            "telephone_number": "586-578-0220",
            "fax_number": "586-578-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922534",
            "telephone_number": "586-578-0220",
            "fax_number": "586-578-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON COMMUNITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "GUNABALAN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-792-1746"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008844",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2807858",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043722",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BC OF MICHIGAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.