| Organization Name: | MADISON MEMORIAL HOSPITAL STOCKHOFF MEMORIAL NURSING HOME |
| NPI Number: | 1306912134 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA MARIE TWIDWELL (CFO) |
| Mailing Address: | 611 West Main Street Fredericktown |
| State: | MO US |
| Postal Code: | 63645 |
| Phone Number: | 5737833341 |
| Fax Number: | 5737831096 |
| NPI Enumeration Date: | 11/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 123005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |