Healthcare Provider Details

I. General information

NPI: 1083903785
Provider Name (Legal Business Name): NICHOLAS ANDREW MADDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE
SPRINGFIELD MO
65807-5287
US

IV. Provider business mailing address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

V. Phone/Fax

Practice location:
  • Phone: 174-269-6115
  • Fax: 417-269-6679
Mailing address:
  • Phone: 417-875-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2019017045
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: