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NPI Code Detail

MEDICARE: DR. THOMAS ALLEN HENDERSON MD

MEDICARE: DR. THOMAS ALLEN HENDERSON MD
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
1207R00000XInternal Medicine Physician39290CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
239290OTHERCOCOLORADO LICENSE

General Provider Information

NPI Number : 1740371020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS ALLEN HENDERSON MD
Provider Business Mailing Address
First Line : 3205 N ACADEMY BLVD
Second Line : SUITE 130
City : COLORADO SPRINGS
State : CO
Zip : 80917-5101
Country : US
Telephone Number : 719-632-5700
Fax Number : 719-344-7837
Provider Business Practice Location Address
First Line : 722 S WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4035
Country : US
Telephone Number : 719-632-5700
Fax Number : 719-344-7817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 03/07/2023

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