Provider Demographics
NPI: | 1639273196 |
---|---|
Name: | MADISON HEALTHCARE SERVICES |
Entity Type: | Organization |
Organization Name: | MADISON HEALTHCARE SERVICES |
Other - Org Name: | MADISON LUTHERAN HOME |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CAROL |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | BORGERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 320-698-7152 |
Mailing Address - Street 1: | 900 2ND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISON |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 56256-1006 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 320-598-7551 |
Mailing Address - Fax: | 320-598-7553 |
Practice Address - Street 1: | 900 2ND AVE |
Practice Address - Street 2: | |
Practice Address - City: | MADISON |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56256-1006 |
Practice Address - Country: | US |
Practice Address - Phone: | 320-598-7551 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-12 |
Last Update Date: | 2017-08-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | C02886 | Medicare PIN |