MEDICARE: DR. THOMAS H HENDERSON 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	207Q00000X	Family Medicine Physician	34001579H	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	08019714	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000227904	OTHER	OH	ANTHEM
2	000000227904	OTHER	OH	UNICARE
4	34001579H	OTHER	OH	MEDICAL LICENSE
5	DO157904	OTHER	OH	HUMANA/CHOICECARE
6	OC02946	OTHER	OH	NATIONWIDE HEALTH PLAN
7	0120071	OTHER	OH	UNITED HEALTHCARE
8	2220247	OTHER	OH	AETNA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	421534506082	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1659374171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS H HENDERSON D.O.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8996
Fax Number	:	937-396-0045

Provider Business Practice Location Address
First Line	:	4120 W FRANKLIN ST
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-1547
Country	:	US
Telephone Number	:	937-848-6421
Fax Number	:	937-848-6391

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	08/19/2009

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