Provider Demographics
NPI:1194846873
Name:MENA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MENA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-437-3602
Mailing Address - Street 1:531 POLK 77
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-7848
Mailing Address - Country:US
Mailing Address - Phone:479-437-3602
Mailing Address - Fax:479-437-3604
Practice Address - Street 1:531 POLK 77
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-7848
Practice Address - Country:US
Practice Address - Phone:479-437-3602
Practice Address - Fax:479-437-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145341002Medicaid
AR145341002Medicaid
5L920Medicare PIN