Provider Demographics
NPI:1245597558
Name:HENDRICK PROVIDER NETWORK
Entity Type:Organization
Organization Name:HENDRICK PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HENDRICK PROVIDER NETWORK ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-6340
Mailing Address - Street 1:2000 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2434
Mailing Address - Country:US
Mailing Address - Phone:325-670-6340
Mailing Address - Fax:
Practice Address - Street 1:2000 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2434
Practice Address - Country:US
Practice Address - Phone:325-670-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647404282N00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No282N00000XHospitalsGeneral Acute Care Hospital