Provider Demographics
NPI:1689095291
Name:ERNEST A KENDRICK, M.D., PA
Entity Type:Organization
Organization Name:ERNEST A KENDRICK, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-330-8519
Mailing Address - Street 1:4915 S MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4601
Mailing Address - Country:US
Mailing Address - Phone:281-242-5808
Mailing Address - Fax:281-241-6714
Practice Address - Street 1:4915 S MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4601
Practice Address - Country:US
Practice Address - Phone:281-242-5808
Practice Address - Fax:281-241-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1935305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization