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NPI Code Detail

MEDICARE: MADISON SHRUM MS, RD, LD

MEDICARE: MADISON SHRUM MS, RD, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2024049612MO

General Provider Information

NPI Number : 1053109975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON SHRUM MS, RD, LD
Provider Business Mailing Address
First Line : 207 E HORNBECK ST
Second Line :
City : SENATH
State : MO
Zip : 63876-9223
Country : US
Telephone Number : 573-559-8595
Fax Number :
Provider Business Practice Location Address
First Line : 1526 SWALLOW DR
Second Line :
City : BRENTWOOD
State : MO
Zip : 63144-1620
Country : US
Telephone Number : 573-559-8595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2025
Last Update Date : 04/29/2025

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