Provider Demographics
NPI:1306029863
Name:HENRY MEDICAL PLLC
Entity Type:Organization
Organization Name:HENRY MEDICAL PLLC
Other - Org Name:PHILIP R HENRY DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-483-3155
Mailing Address - Street 1:42 E ROWAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1212
Mailing Address - Country:US
Mailing Address - Phone:509-483-3155
Mailing Address - Fax:509-483-3270
Practice Address - Street 1:42 E ROWAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1212
Practice Address - Country:US
Practice Address - Phone:509-483-3155
Practice Address - Fax:509-483-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADOOP00001500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160793OtherWA LABOR AND INDUSTRIES
WA116060Medicaid
G30327Medicare UPIN
WA116060Medicaid