Healthcare Provider Details

I. General information

NPI: 1114669538
Provider Name (Legal Business Name): MADDEN ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR STE 600
GLEN BURNIE MD
21061-5865
US

IV. Provider business mailing address

3301 S 14TH ST STE 16180
ABILENE TX
79605-5015
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-3937
  • Fax:
Mailing address:
  • Phone: 325-660-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: POPPY WALKER
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 325-660-5535