Provider Demographics
NPI:1760460927
Name:HENDRICK SOUTHWESTERN HEALTH DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:HENDRICK SOUTHWESTERN HEALTH DEVELOPMENT CORPORATION
Other - Org Name:HENDRICK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-6067
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-0115
Mailing Address - Country:US
Mailing Address - Phone:325-673-3711
Mailing Address - Fax:325-673-4639
Practice Address - Street 1:105 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7117
Practice Address - Country:US
Practice Address - Phone:325-235-8500
Practice Address - Fax:325-235-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0035126332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107626701OtherMEDICAID CCP PROGRAM
TX017032601Medicaid
TXB519895OtherBLUE CROSS BLUE SHIELD
TX017032601Medicaid