MEDICARE: MADISON COMMUNITY HOSPITAL

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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1447563432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	30785 STEPHENSON HWY
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1618
Country	:	US
Telephone Number	:	248-556-4160
Fax Number	:

Provider Business Practice Location Address
First Line	:	30785 STEPHENSON HWY
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1618
Country	:	US
Telephone Number	:	248-556-4160
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. RYAN GUNABALAN
Credential	:
Telephone Number	:	586-261-2266

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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Directions to “MADISON COMMUNITY HOSPITAL ” Practice Location

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