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General NPI Number Information
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NPI Number | 1720163025
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Entity Type | Organization
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Legal Business Name | MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 611 W MAIN ST
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-1111
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Country | US
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Telephone | 573-783-3341
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Fax | 573-783-1096
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Provider Business Mailing Address
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Address Line | 611 W MAIN ST PO BOX 431
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-1111
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Country | US
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Telephone | 573-783-3341
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Fax | 573-783-1096
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Authorized Official
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Title or Position | CFO
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Name | MS. LISA MARIE TWIDWELL
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Credential |
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Telephone | 573-783-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 209-45
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License Number State | MO
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