Madison Ear Nose and Throat Clinic

NPI #1265458400 in Rexburg, Idaho

Provider Information

NPI Number: 1265458400
Entity Type: Organization
Organization Name: Madison Ear Nose and Throat Clinic
Primary Specialty: Otolaryngology
Enumeration Date: Jul 14, 2006
Last Updated: Jan 17, 2012

Practice Location

Address: 30 MADISON PROFESSIONAL PARK
City: Rexburg
State: Idaho
ZIP Code: 83440-2058
Phone: (208) 656-9646

Authorized Official

Name: MRS. DEBBIE SUE BULSTRODE
Title: OFFICE MANAGER
Phone: (208) 656-9646

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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