1144701582 NPI number — MADSEN INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144701582 NPI number — MADSEN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADSEN INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GLADBROOK FAMILY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144701582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADBROOK
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50635-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-473-0066
Provider Business Mailing Address Fax Number:
641-473-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 2ND. ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLADBROOK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50635-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-473-0066
Provider Business Practice Location Address Fax Number:
641-473-0069
Provider Enumeration Date:
08/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TOWNSEND
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
641-484-6198

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  1658 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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