1073714697 NPI number — PATRICK B. HENDERSON

Table of content: (NPI 1073714697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073714697 NPI number — PATRICK B. HENDERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK B. HENDERSON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KARMA MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073714697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E ARAPAHO RD
Provider Second Line Business Mailing Address:
313
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75081-2765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-235-4200
Provider Business Mailing Address Fax Number:
972-235-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E ARAPAHO RD
Provider Second Line Business Practice Location Address:
313
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75081-2765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-235-4200
Provider Business Practice Location Address Fax Number:
972-235-2300
Provider Enumeration Date:
05/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDESON
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
BOUVIER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-235-4200

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  0090326 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 0090326 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 0090326 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 183415201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".