Provider Demographics
NPI:1740035831
Name:HERRING, SAMUEL JR
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:HERRING
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-4550
Mailing Address - Country:US
Mailing Address - Phone:317-714-9911
Mailing Address - Fax:317-541-0075
Practice Address - Street 1:4530 E 42ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4550
Practice Address - Country:US
Practice Address - Phone:317-714-9911
Practice Address - Fax:317-541-0075
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN240170361172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker