=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801948880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADISON MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 10/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 W MAIN ST
-----------------------------------------------------
City | FREDERICKTOWN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63645-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-783-1047
-----------------------------------------------------
Fax | 573-783-1063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 W MAIN ST PO BOX 431
-----------------------------------------------------
City | FREDERICKTOWN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63645-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | LINDA HATCH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 573-783-1047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 003980
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------