MEDICARE: HENDERSON CLINIC FOR WOMEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	39877	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7808539	OTHER	NC	AETNA GROUP ID
3	16402	OTHER	NC	WELLPATH GROUP ID

General Provider Information

NPI Number	:	1104829183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON CLINIC FOR WOMEN PA

Provider Business Mailing Address
First Line	:	511 RUIN CREEK RD
Second Line	:	STE 101
City	:	HENDERSON
State	:	NC
Zip	:	27536-5919
Country	:	US
Telephone Number	:	252-492-8576
Fax Number	:	252-492-7464

Provider Business Practice Location Address
First Line	:	511 RUIN CREEK RD
Second Line	:	STE 101
City	:	HENDERSON
State	:	NC
Zip	:	27536-5919
Country	:	US
Telephone Number	:	252-492-8576
Fax Number	:	252-492-7464

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. NANCY P KING
Credential	:
Telephone Number	:	252-492-8576

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1912996323 — PAULA M LEIF CRNP
Practice Location Address:

511 RUIN CREEK RD , SUITE 103
HENDERSON, NC
27536-5919

Practice Phone: 252-430-7700
Practice Fax: 252-430-8612

1912985482 — DR. DONALD SERAFIN M.D.
Practice Location Address:

511 RUIN CREEK RD , #104B
HENDERSON, NC
27536-5919

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1043290422 — DR. SAMUEL G MCCASKILL JR. MD
Practice Location Address:

511 RUIN CREEK RD
HENDERSON, NC
27536-5919

Practice Phone: 252-492-8576
Practice Fax: 252-492-7464

1821060583 — DR. DANIELLE RENEE KWAKYE-BERKO MD
Practice Location Address:

511 RUIN CREEK RD STE 101
HENDERSON, NC
27536-5919

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Practice Fax: 252-436-0281

1467420182 — DR. VALARMATHI SUNDAR MD
Practice Location Address:

511 RUIN CREEK RD , SUITE: 203
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27536-5919

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Practice Fax:

1144298886 — DR. VEERAPPAN SUNDAR MD
Practice Location Address:

511 RUIN CREEK RD , 203
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Practice Fax:

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