Provider Demographics
NPI:1780005470
Name:PANHANDLE DIALYSIS MEDICAL DIRECTORS, PA
Entity Type:Organization
Organization Name:PANHANDLE DIALYSIS MEDICAL DIRECTORS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-418-8620
Mailing Address - Street 1:1805 POINT WEST PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2165
Mailing Address - Country:US
Mailing Address - Phone:806-418-8620
Mailing Address - Fax:
Practice Address - Street 1:1805 POINT WEST PKWY
Practice Address - Street 2:STE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2165
Practice Address - Country:US
Practice Address - Phone:806-418-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty