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NPI Code Detail

MEDICARE: MADISON GENERAL SURGERY CLINIC

MEDICARE: MADISON GENERAL SURGERY CLINIC
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
1208600000XSurgery Physician40ID

General Provider Information

NPI Number : 1437237989
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON GENERAL SURGERY CLINIC
Provider Business Mailing Address
First Line : PO BOX 310
Second Line :
City : REXBURG
State : ID
Zip : 83440-0310
Country : US
Telephone Number : 208-356-9086
Fax Number : 208-356-3111
Provider Business Practice Location Address
First Line : 393 E 2ND N
Second Line :
City : REXBURG
State : ID
Zip : 83440-1605
Country : US
Telephone Number : 208-356-9086
Fax Number : 208-356-3111
Authorized Official
Title or Position : CFO
Name : CALVIN W CAREY
Credential :
Telephone Number : 208-356-3691
Provider Enumeration Date : 11/01/2006
Last Update Date : 08/22/2020

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Directions to “MADISON GENERAL SURGERY CLINIC ” Practice Location

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