Provider Demographics
NPI:1376978437
Name:MADISON COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:MADISON COMMUNITY HOSPITAL INC
Other - Org Name:SAMARITAN LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-619-9771
Mailing Address - Street 1:30781 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1618
Mailing Address - Country:US
Mailing Address - Phone:248-284-2316
Mailing Address - Fax:248-583-8969
Practice Address - Street 1:17200 E 10 MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3355
Practice Address - Country:US
Practice Address - Phone:248-619-9771
Practice Address - Fax:248-583-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory