Provider Demographics
NPI:1588317010
Name:GHENDA, VICK M
Entity type:Individual
Prefix:
First Name:VICK
Middle Name:M
Last Name:GHENDA
Suffix:
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 1:3702 ROLLING GREEN DR APT 8101
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2881
Mailing Address - Country:US
Mailing Address - Phone:325-513-7240
Mailing Address - Fax:
Practice Address - Street 1:3702 ROLLING GREEN DR APT 8101
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2881
Practice Address - Country:US
Practice Address - Phone:325-513-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)