Provider Demographics
NPI:1043405848
Name:TERRY L. HENDERSON, M.D., INC.
Entity Type:Organization
Organization Name:TERRY L. HENDERSON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOTLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-846-4366
Mailing Address - Street 1:8801 N MERIDIAN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5315
Mailing Address - Country:US
Mailing Address - Phone:317-846-4366
Mailing Address - Fax:317-815-2249
Practice Address - Street 1:8801 N MERIDIAN ST STE 208
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5315
Practice Address - Country:US
Practice Address - Phone:317-846-4366
Practice Address - Fax:317-815-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083676OtherANTHEM BC BS
IN071250Medicare PIN
IN000000083676OtherANTHEM BC BS