Provider Demographics
NPI:1962575811
Name:MADELIA HEALTH
Entity type:Organization
Organization Name:MADELIA HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TETZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-642-3255
Mailing Address - Street 1:121 DREW AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1841
Mailing Address - Country:US
Mailing Address - Phone:507-642-3255
Mailing Address - Fax:507-642-8516
Practice Address - Street 1:121 DREW AVENUE SE
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1841
Practice Address - Country:US
Practice Address - Phone:507-642-3255
Practice Address - Fax:507-642-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN351876251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1727AMAOtherBLUE CROSS PROVIDER NUMBE
MN174747900Medicaid
MN121652OtherUCARE PROVIDER NUMBER
MN121652OtherUCARE PROVIDER NUMBER
MN174747900Medicaid
24-7202Medicare PIN