1386741684 NPI number — MADISON HEALTHCARE SERVICES

Table of content: (NPI 1386741684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386741684 NPI number — MADISON HEALTHCARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON HEALTHCARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MADISON HOME HEALTH AGENCY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386741684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SECOND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56256-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-598-7551
Provider Business Mailing Address Fax Number:
320-598-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SECOND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56256-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-598-7556
Provider Business Practice Location Address Fax Number:
320-598-3470
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORGERSON
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
320-698-7152

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 375556 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 961355200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125927 . This is a "HOME HEALTH UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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