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NPI Code Detail

MEDICARE: MR. JAMES ALEX HENDERSON SR. HIS

MEDICARE: MR. JAMES ALEX HENDERSON SR. HIS
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
1237700000XHearing Instrument Specialist2101001271VA

General Provider Information

NPI Number : 1821489295
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES ALEX HENDERSON SR. HIS
Provider Business Mailing Address
First Line : 750 N COMMONS DR STE 200
Second Line :
City : AURORA
State : IL
Zip : 60504-7940
Country : US
Telephone Number : 630-303-5380
Fax Number : 630-303-5385
Provider Business Practice Location Address
First Line : 3610 FESTIVAL PARK PLZ
Second Line : SUITE A
City : CHESTER
State : VA
Zip : 23831-4422
Country : US
Telephone Number : 804-796-3210
Fax Number : 804-796-3210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2015
Last Update Date : 03/23/2021

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