Provider Demographics
NPI:1023157682
Name:HENDRIX MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:HENDRIX MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DEWANE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-236-7272
Mailing Address - Street 1:2709 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4141
Mailing Address - Country:US
Mailing Address - Phone:870-236-7272
Mailing Address - Fax:870-236-7275
Practice Address - Street 1:2709 W KINGSHIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4141
Practice Address - Country:US
Practice Address - Phone:870-236-7272
Practice Address - Fax:870-236-7275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRIX MEDICAL SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130230001Medicaid
ARCI2041OtherRAILROAD MEDICARE