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General NPI Number Information
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NPI Number | 1801198221
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Entity Type | Organization
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Legal Business Name | HIDDEN LAKES HEALTH CENTER PLLC
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 8861 DAVIS BOULEVARD
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 817-753-6561
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Fax | 817-753-6598
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Provider Business Mailing Address
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Address Line | 8861 DAVIS BOULEVARD
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 817-753-6561
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Fax | 817-753-6598
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Authorized Official
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Title or Position | VP
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Name | JEFF HENDERSON
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Credential |
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Telephone | 972-401-8720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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