Provider Demographics
NPI:1588890883
Name:MAX A HENRY MD
Entity type:Organization
Organization Name:MAX A HENRY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-372-4463
Mailing Address - Street 1:825 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1330
Mailing Address - Country:US
Mailing Address - Phone:812-663-7222
Mailing Address - Fax:812-663-9559
Practice Address - Street 1:825 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1330
Practice Address - Country:US
Practice Address - Phone:812-663-7222
Practice Address - Fax:812-663-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030454A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200823550BMedicaid
IN100052270Medicaid
IN252470Medicare PIN
IN100052270Medicaid
IN0235330002Medicare NSC