# MADISON CO MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MADISON CO MEMORIAL HOSPITAL
- **Other names:** Madison Memorial Rexburg Medical Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134592017
- **Legal business name:** MADISON CO MEMORIAL HOSPITAL
- **Authorized official:** RACHEL GONZALES DM, RN, RODP (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (208) 359-6900

## Contact information

- **Practice address:** 393 E 2ND N, REXBURG, ID 83440-1605
- **Practice address phone:** (208) 356-5401
- **Practice address fax:** (208) 356-3111
- **Mailing address:** 393 E 2ND N, REXBURG, ID 83440-1605
- **Mailing address phone:** (208) 356-5401
- **Mailing address fax:** (208) 356-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 40 | ID | Yes |

## Other

- **Enumeration date:** 11/02/2015
- **Last updated:** 10/23/2023