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MADISON MEMORIAL HOSPITAL
NPI 1821342247
Non-Pharmacy Dispensing Site in Rexburg, ID

Active since November 07, 2012CLIA 13D0521001 · Certificate of Compliance
450 E MAIN ST, REXBURG, ID 83440(208) 359-6900 Get Directions Write a Review

NPPES record last updated: November 7, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Madison Memorial Hospital NPPES

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

MADISON MEMORIAL HOSPITAL (NPI 1821342247) is a healthcare organization registered as a non-pharmacy dispensing site in Rexburg, Idaho and active in the NPI registry since November 2012. The organization holds a CLIA Certificate of Compliance certificate valid through March 23, 2027 and lists Dorsie Sullenger, Director Of Pharmacy, as its authorized official.

NPPES Registry Identity

NPI1821342247
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameMADISON MEMORIAL HOSPITAL
Location Address450 E MAIN STRexburg, ID 83440-2048
Mailing Address6501 City West PkwyEden Prairie, MN 55344-3248 · (952) 653-2525
Phone(208) 359-6900
Organization SubpartYes
Authorized OfficialDorsie SullengerDirector Of Pharmacy · (208) 359-6900
Enumeration DateNovember 7, 2012
✔ NPI 1821342247 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

450 E MAIN ST, Rexburg, ID 83440
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Antidote Health Plan of Arizona, Inc., Antidote Health Plan of Ohio, Inc. and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 13D0521001

Madison Memorial Hospital Lab · Rexburg, ID
Active · expires Mar 23, 2027
CLIA Number13D0521001
Laboratory TypeHospital
Certificate Effective DateMarch 24, 2025
Certificate Expiration DateMarch 23, 2027
Laboratory DirectorGabrielle Teerman
Laboratory Phone(208) 359-6442
Laboratory LocationMadison Memorial Hospital Lab450 E Main St, Rexburg, ID 83440
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 20

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

MADISON PHYSICIAN SERVICES
Emergency Medicine
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 359-9898
TODD GEHMLICH CRNA
Nurse Anesthetist, Certified Registered
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691
MADISON ANESTHESIA SERVICES PA
Nurse Anesthetist, Certified Registered
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691
CINDI FARNWORTH CRNA
Nurse Anesthetist, Certified Registered
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691
JEFFREY T GROVER CRNA
Nurse Anesthetist, Certified Registered
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691
DR. DAVID VICTOR HANSEN M.D.
Radiology (Diagnostic Radiology)
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 359-6508
KURT R MAYBERRY MD
Emergency Medicine
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691
DEBRA BRAND MD
Emergency Medicine
450 E MAIN ST
REXBURG, ID 83440
Madison County (208) 356-3691

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madison Memorial Hospital's NPI number?

The NPI number for Madison Memorial Hospital is 1821342247. It was assigned to this organization in the NPPES registry on November 7, 2012.

Where is Madison Memorial Hospital located?

Madison Memorial Hospital is located at 450 E Main St, Rexburg, ID 83440. The listed phone number is (208) 359-6900.

What is Madison Memorial Hospital's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Madison Memorial Hospital hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 13D0521001) is associated with this NPI, valid through March 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Madison Memorial Hospital accept?

Health plans from Anthem Blue Cross and Blue Shield, Antidote Health Plan of Arizona, Inc., Antidote Health Plan of Ohio, Inc., Avera Health Plans and Baylor Scott and White Health Plan and 17 other insurers list Madison Memorial Hospital as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Madison Memorial Hospital was last updated on November 7, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.