Provider Demographics
NPI:1922398601
Name:DR ROBERT HENDRICKS INC
Entity Type:Organization
Organization Name:DR ROBERT HENDRICKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-542-2315
Mailing Address - Street 1:P.O. BOX 579
Mailing Address - Street 2:10251 MAIN STREET
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442
Mailing Address - Country:US
Mailing Address - Phone:330-542-2315
Mailing Address - Fax:330-542-9700
Practice Address - Street 1:10251 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:44442
Practice Address - Country:US
Practice Address - Phone:330-542-2315
Practice Address - Fax:330-542-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74602Medicare UPIN