Provider Demographics
NPI:1376684183
Name:HENDRIX MEDICAL SERVICES, P.L.L.C.
Entity type:Organization
Organization Name:HENDRIX MEDICAL SERVICES, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-236-3388
Mailing Address - Street 1:2709 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4141
Mailing Address - Country:US
Mailing Address - Phone:870-236-3388
Mailing Address - Fax:870-236-2656
Practice Address - Street 1:2709 W KINGSHIGHWAY
Practice Address - Street 2:SUITE 8
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4141
Practice Address - Country:US
Practice Address - Phone:870-236-3388
Practice Address - Fax:870-236-2656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRIX MEDICAL SERVICES, P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0966207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCI2041OtherRAILROAD MEDICARE
ARCI2041OtherRAILROAD MEDICARE