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General NPI Number Information
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NPI Number | 1982827945
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Entity Type | Organization
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Legal Business Name | HENDERSON MEDICAL CLINIC, PA
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 409 8TH ST
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City | ABERNATHY
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State | TX
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Zip | 79311-3416
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Country | US
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Telephone | 806-298-5884
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Fax | 806-298-5889
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Provider Business Mailing Address
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Address Line | 409 8TH ST
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City | ABERNATHY
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State | TX
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Zip | 79311-3416
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Country | US
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Telephone | 806-298-5884
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Fax | 806-298-5889
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. BRYAN L WILLIAMS
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Credential | BBA
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Telephone | 806-771-1166
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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 | K5115
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 533693
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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