1144363771 NPI number — DR. WILLIAM O HENRY MD

Table of content: DR. WILLIAM O HENRY MD (NPI 1144363771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144363771 NPI number — DR. WILLIAM O HENRY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
WILLIAM
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1144363771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39505-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-314-7226
Provider Business Mailing Address Fax Number:
228-314-7227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14245 DEDEAUX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-314-7226
Provider Business Practice Location Address Fax Number:
228-314-7227
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  08744 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: F7484 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1906808 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3504397 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10410 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1995131 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: X9X008188 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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