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General NPI Number Information
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NPI Number | 1003897661
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Entity Type | Individual
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Provider Name | BRENT L MADSEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 914 N SCOTTSDALE RD STE 104
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City | TEMPE
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State | AZ
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Zip | 85288-2116
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Country | US
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Telephone | 480-924-8382
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Fax | 480-966-0566
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Provider Business Mailing Address
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Address Line | 120 PARK AVE
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City | HEBRON
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State | NE
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Zip | 68370-2019
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Country | US
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Telephone | 402-768-7203
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Fax | 402-768-4669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 631
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9900
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5119
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 631
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License Number State | NE
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