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NPI Code Detail

MEDICARE: DR. REGGIE ALLAN HENDERSON M.D.

MEDICARE: DR. REGGIE ALLAN HENDERSON 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
1207P00000XEmergency Medicine Physician12019TN
2207R00000XInternal Medicine Physician12019TN
3208000000XPediatrics Physician12019TN
4208100000XPhysical Medicine & Rehabilitation Physician12019TN
52085R0202XDiagnostic Radiology Physician12019TN
6208600000XSurgery Physician12019TN
7207Q00000XFamily Medicine Physician12019TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00034973OTHERTNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14057341OTHERTNBLUE CROSS BLUE SHIELD
2626001636OTHERTNUSA MANAGED CARE
3152666OTHERTNUNISON
4JT1012OTHERTNCIGNA
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7626001636OTHERTNHEALTH PARTNERS
827415OTHERTNTLC
9626001636OTHERTNUNITED HEALTHCARE

General Provider Information

NPI Number : 1528058765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REGGIE ALLAN HENDERSON M.D.
Provider Business Mailing Address
First Line : 200 W CHURCH ST
Second Line :
City : LEXINGTON
State : TN
Zip : 38351-2038
Country : US
Telephone Number : 731-968-3646
Fax Number : 731-968-1870
Provider Business Practice Location Address
First Line : 200 W CHURCH ST
Second Line :
City : LEXINGTON
State : TN
Zip : 38351-2038
Country : US
Telephone Number : 731-968-3646
Fax Number : 731-968-1870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 06/14/2024

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