Provider Demographics
NPI:1922000140
Name:HENTZ MEDICAL, INC
Entity Type:Organization
Organization Name:HENTZ MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-870-9194
Mailing Address - Street 1:900 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3110
Mailing Address - Country:US
Mailing Address - Phone:817-870-9194
Mailing Address - Fax:817-870-1473
Practice Address - Street 1:900 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3110
Practice Address - Country:US
Practice Address - Phone:817-870-9194
Practice Address - Fax:817-870-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0593350001Medicare NSC
TX6188820001Medicare NSC