Provider Demographics
NPI:1588644058
Name:MADISON COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:MADISON COMMUNITY HOSPITAL
Other - Org Name:MADISON REGIONAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:605-256-6551
Mailing Address - Street 1:323 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3200
Mailing Address - Country:US
Mailing Address - Phone:605-256-6551
Mailing Address - Fax:605-256-6469
Practice Address - Street 1:323 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3200
Practice Address - Country:US
Practice Address - Phone:605-256-6551
Practice Address - Fax:605-256-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 251E00000X, 251G00000X, 3336I0012X, 341600000X
SD49870282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD80007OtherHOSPITAL
SD0159090Medicaid
SD10501905Medicaid
SD43-0007OtherHOSPITAL
SD5500070Medicaid
SD0170910Medicaid
SD0100070Medicaid
SD5590270Medicaid
SD8U007OtherSWING BED
SD9010100Medicaid
SD5500070Medicaid
SD431300Medicare Oscar/Certification
SD10501905Medicaid