Basic Information
| Provider Information | |||||||||
| NPI: | 1902883754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 DANNY THOMAS PL # MS 515 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381053678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015953006 | ||||||||
| FaxNumber: | 9015953842 | ||||||||
| Practice Location | |||||||||
| Address1: | 262 DANNY THOMAS PL | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381053678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015953300 | ||||||||
| FaxNumber: | 9015953842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 12/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 40553 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0207X | 37587 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 150215502 | 05 | TX | MEDICAID | 150215503 | 01 | TX | CSN | OTHER | Q020362 | 05 | TN | MEDICAID | 009934486 | 05 | AL | MEDICAID | 200071130A | 05 | OK | MEDICAID | 207368903 | 05 | MO | MEDICAID | 8CL613 | 01 | TX | BCBS | OTHER | 02750818 | 05 | MS | MEDICAID | 0717173 | 05 | IA | MEDICAID | 200378480A | 05 | KS | MEDICAID | 5440667 | 05 | TN | MEDICAID | 158594001 | 05 | AR | MEDICAID | 200803590A | 05 | IN | MEDICAID |