Healthcare Provider Details

I. General information

NPI: 1073154266
Provider Name (Legal Business Name): MADISON CO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S 2ND E
REXBURG ID
83440-1906
US

IV. Provider business mailing address

37 S 2ND E
REXBURG ID
83440-1906
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-0234
  • Fax:
Mailing address:
  • Phone: 208-656-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL GONZALES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DM, RN, RODP
Phone: 208-359-6900