Provider Demographics
NPI:1942376025
Name:WHITE COUNTY FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:WHITE COUNTY FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-253-6691
Mailing Address - Street 1:800 N ADAMS ST
Mailing Address - Street 2:PO BOX 748
Mailing Address - City:MONON
Mailing Address - State:IN
Mailing Address - Zip Code:47959-0748
Mailing Address - Country:US
Mailing Address - Phone:219-253-6691
Mailing Address - Fax:219-253-6173
Practice Address - Street 1:800 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:MONON
Practice Address - State:IN
Practice Address - Zip Code:47959
Practice Address - Country:US
Practice Address - Phone:219-253-6691
Practice Address - Fax:219-253-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100262700AMedicaid
INMO920800Medicare PIN
INMO920800Medicare PIN