MEDICARE: RICKY DALE HENDRIX M.D.

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	207RN0300X	Nephrology Physician	MD.016338	LA
2	174400000X	Specialist	MD.016338	LA

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

General Provider Information

NPI Number	:	1124021381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY DALE HENDRIX M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1334
Second Line	:
City	:	WINNFIELD
State	:	LA
Zip	:	71483-1334
Country	:	US
Telephone Number	:	318-628-5565
Fax Number	:	318-628-5950

Provider Business Practice Location Address
First Line	:	201 4TH ST STE 5A
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-8421
Country	:	US
Telephone Number	:	318-483-1961
Fax Number	:	318-483-1964

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/19/2024

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