Provider Demographics
NPI:1417173840
Name:RICHARD E HENDRIX, MD INC
Entity Type:Organization
Organization Name:RICHARD E HENDRIX, MD INC
Other - Org Name:HENDRIX FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-788-1900
Mailing Address - Street 1:4825 S HIGHWAY 95
Mailing Address - Street 2:SUITE 5 #503
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-8315
Mailing Address - Country:US
Mailing Address - Phone:928-788-1900
Mailing Address - Fax:928-788-2048
Practice Address - Street 1:1611 JOY LN
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-8807
Practice Address - Country:US
Practice Address - Phone:928-788-1900
Practice Address - Fax:928-788-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER