MEDICARE: MARIAN K HENDRICKS D.O.

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	207P00000X	Emergency Medicine Physician	L2933	TX
2	207Q00000X	Family Medicine Physician	L2933	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1L5763	OTHER	TX	MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P02601766	OTHER	TX	MCRR
5	00K51Q	OTHER	TX	BCBS GROUP/COAST. BND FAM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	8G1442	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1114915451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN K HENDRICKS D.O.

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-0996

Provider Business Practice Location Address
First Line	:	5802 SARATOGA BLVD
Second Line	:	STE 150
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4252
Country	:	US
Telephone Number	:	361-986-4600
Fax Number	:	361-985-0305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	04/09/2021

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