Healthcare Provider Details

I. General information

NPI: 1043287634
Provider Name (Legal Business Name): HENRY H CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOOD SAMARITAN REGIONAL HEALTH CENTER 605 N 12 ST
MT VERNON IL
62864
US

IV. Provider business mailing address

622 S DEER LAKE DR E
CARBONDALE IL
62901-5256
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-4600
  • Fax:
Mailing address:
  • Phone: 618-351-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: