Individual ProviderMadeline TennantPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2801 W Kk River Pkwy Ste 370, Milwaukee, WI 53215-3678(414) 649-7900(800) 326-2250PECOS EnrollmentBased on the most recent information from CMS, provider Madeline Tennant is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:26 AM.Profile DetailsProvider ID1255823233Provider TypeIndividualFull NameTennant, MadelineGenderFemaleSole ProprietorNoEnumeration Date6/5/2018Last Updated12/20/2023Contact InformationPractice LocationPractice Address2801 W Kk River Pkwy Ste 370, Milwaukee, WI 53215-3678Phone(414) 649-7900FaxUnlisted FaxMailing LocationMailing AddressPO Box 735044, Chicago, IL 60673-5044Phone(800) 326-2250FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense100962WisconsinCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense085-006588IllinoisProvider IdentifiersIDDescriptionIssuerID100253415DescriptionMedicaidIssuerUnlistedWisconsin