1891792834 NPI number — HEALTHCARE CENTER OF HENDERSON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891792834 NPI number — HEALTHCARE CENTER OF HENDERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE CENTER OF 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:
Provider Other Organization Name Type Code:
6
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:
1891792834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77903-7230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-576-9454
Provider Business Mailing Address Fax Number:
361-576-2994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SOUTHWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75654-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-6506
Provider Business Practice Location Address Fax Number:
903-655-8578
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
361-576-9454

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  110773 , 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: 4894720001 . This is a "DMERC PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4912 . This is a "VENDOR NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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