Provider Demographics
NPI:1912966656
Name:HENDERSONVILLE PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:HENDERSONVILLE PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-693-3296
Mailing Address - Street 1:600 BEVERLY HANKS CTR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2305
Mailing Address - Country:US
Mailing Address - Phone:828-693-3296
Mailing Address - Fax:828-696-3530
Practice Address - Street 1:600 BEVERLY HANKS CTR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2305
Practice Address - Country:US
Practice Address - Phone:828-693-3296
Practice Address - Fax:828-696-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01764Medicaid