Provider Demographics
NPI:1083885958
Name:ALBERT L HENRY, MD
Entity Type:Organization
Organization Name:ALBERT L HENRY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ROBYN
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-269-6565
Mailing Address - Street 1:1665 KINGSLEY AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4415
Mailing Address - Country:US
Mailing Address - Phone:904-269-6565
Mailing Address - Fax:904-264-0529
Practice Address - Street 1:1665 KINGSLEY AVE
Practice Address - Street 2:STE 107
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4415
Practice Address - Country:US
Practice Address - Phone:904-269-6565
Practice Address - Fax:904-264-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054173332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07472OtherBCBS OF FLORIDA
FL4523030001Medicare NSC
FL07472Medicare PIN
FLC28840Medicare UPIN