Organization
MADISON PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL A. GONZALES DM, RN (CEO)
(208) 359-9879
Entity
Organization
Contact information
Practice address
450 E MAIN ST, REXBURG, ID 83440-2048
(208) 359-9898
(208) 359-6764
Mailing address
PO BOX 700, REXBURG, ID 83440-0700
(208) 359-9898
(208) 359-6764
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
40
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006290
REGENCE BLUE SHIELD OF ID
ID
05
—
002855800
—
ID
01
—
8K867
BLUE CROSS OF IDAHO
ID
Enumeration date
06/11/2006
Last updated
06/05/2012
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