Healthcare Provider Details

I. General information

NPI: 1568461663
Provider Name (Legal Business Name): HENDRICK SOUTHWESTERN HEALTH DEVELOPEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 HICKORY ST
ABILENE TX
79601-2336
US

IV. Provider business mailing address

1934 HICKORY ST
ABILENE TX
79601-2336
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-2134
  • Fax: 325-670-4390
Mailing address:
  • Phone: 325-670-2134
  • Fax: 325-670-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: TIM RILEY
Title or Position: DIRECTOR
Credential:
Phone: 325-670-2134