Provider Demographics
NPI:1598761652
Name:HENDRICK MEDICAL CENTER
Entity Type:Organization
Organization Name:HENDRICK MEDICAL CENTER
Other - Org Name:HENDRICK HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-2000
Mailing Address - Street 1:4310 BUFFALO GAP RD # 2001
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2724
Mailing Address - Country:US
Mailing Address - Phone:325-670-2490
Mailing Address - Fax:325-677-5643
Practice Address - Street 1:4310 BUFFALO GAP RD # 2001
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2724
Practice Address - Country:US
Practice Address - Phone:325-670-2490
Practice Address - Fax:325-677-5643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRICK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH9267OtherBLUE CROSS BLUE SHEILD
TX138644305Medicaid