MADISON MEDICAL CENTER
NPI 1003983859
Pharmacy in Fredericktown, MO

Q: What is Madison Memorial Hospital Stockhoff Memorial Nursing Home's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Active since November 29, 2006CLIA Certified · 3 labs

611 WEST MAIN STREET, FREDERICKTOWN, MO 63645(573) 783-3341(573) 783-1096 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Madison Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADISON MEDICAL CENTER (NPI 1003983859) is a healthcare organization registered as a pharmacy in Fredericktown, Missouri and active in the NPI registry since November 2006. The organization holds 3 active CLIA laboratory certificates and lists Lisa Marie Twidwell, Cfo, as its authorized official.

NPPES Registry Identity

NPI1003983859

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameMADISON MEMORIAL HOSPITAL STOCKHOFF MEMORIAL NURSING HOME

Location Address611 WEST MAIN STREETFredericktown, MO 63645

Mailing AddressPo Box 431, 611 West Main StreetFredericktown, MO 63645 · (573) 783-3341 · Fax (573) 783-1096

Phone(573) 783-3341

Fax(573) 783-1096

Organization SubpartNo

Authorized OfficialLisa Marie TwidwellCfo · (573) 783-3341

Enumeration DateNovember 29, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1003983859 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

Definition

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

611 WEST MAIN STREET, Fredericktown, MO 63645

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Other Names 1

Doing Business AsMadison Medical Center

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 26D0441828

Madison Medical Center · Fredericktown, MO

Active · expires Nov 2, 2026

CLIA Number26D0441828

Laboratory TypeHospital

Certificate Effective DateNovember 3, 2024

Certificate Expiration DateNovember 2, 2026

Laboratory DirectorRussell D. Deidiker

Laboratory Phone(573) 783-3341

Laboratory LocationMadison Medical Center611 West Main, Fredericktown, MO 63645

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 26D2193644

Madison Medical Center · Fredericktown, MO

Active · expires Sep 22, 2026

CLIA Number26D2193644

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 23, 2024

Certificate Expiration DateSeptember 22, 2026

Laboratory DirectorLisa Twidwell

Laboratory Phone(573) 783-3341

Laboratory LocationMadison Medical Center611 West Main Street, Fredericktown, MO 63645

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 26D1002138

Madison Medical Center · Fredericktown, MO

Active · expires Jul 29, 2026

CLIA Number26D1002138

Laboratory TypeRural Health Clinic

Certificate Effective DateJuly 30, 2024

Certificate Expiration DateJuly 29, 2026

Laboratory DirectorEric K. Davis

Laboratory Phone(573) 783-8687

Laboratory LocationMadison Medical Center611 West Main Street, Fredericktown, MO 63645

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JULIE MARIE BUFORD WHNP, FNP

Nurse Practitioner (Women's Health)

611 WEST MAIN STREET, SUITE E
FREDERICKTOWN, MO 63645

Madison County (573) 783-3341

MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME

Skilled Nursing Facility