Madison Co Memorial Hospital
NPI 1477122570ActiveOrganization· Psychiatry & Neurology, Psychiatry· Rexburg, ID
Psychiatry & Neurology, Psychiatry in Rexburg, Idaho, registered in NPPES in June 2021, part of Madison Co Memorial Hospital. The authorized official on file is Jaime Tanner, Ambulatory Revenue Manager.
Overview
| NPI | 1477122570 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Madison Co Memorial Hospital |
| NPI issued | Jun 22, 2021 |
| Last updated in NPPES | Jul 29, 2026 |
| Certified by provider | Jul 29, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychiatry & Neurology, Psychiatry Primary | 2084P0800X | — | — |
| Social Worker, Clinical | 1041C0700X | — | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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