Provider Demographics
NPI:1477789774
Name:MAX A HENRY MD
Entity Type:Organization
Organization Name:MAX A HENRY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-372-4463
Mailing Address - Street 1:301 HENRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1030
Mailing Address - Country:US
Mailing Address - Phone:812-346-3858
Mailing Address - Fax:812-346-3588
Practice Address - Street 1:301 HENRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1030
Practice Address - Country:US
Practice Address - Phone:812-346-3858
Practice Address - Fax:812-346-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034054A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200823550CMedicaid
IN252470Medicare PIN
IN200823550CMedicaid
INC24189Medicare UPIN