Healthcare Provider Details

I. General information

NPI: 1922398601
Provider Name (Legal Business Name): DR ROBERT HENDRICKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 MAIN STREET
NEW MIDDLETOWN OH
44442
US

IV. Provider business mailing address

P.O. BOX 579 10251 MAIN STREET
NEW MIDDLETOWN OH
44442
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-2315
  • Fax: 330-542-9700
Mailing address:
  • Phone: 330-542-2315
  • Fax: 330-542-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2094
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT EDWARD HENDRICKS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 330-542-2315