Provider Demographics
NPI:1992260707
Name:HENDRICK PROVIDER NETWORK
Entity type:Organization
Organization Name:HENDRICK PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-4220
Mailing Address - Street 1:2371 CROCKETT DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-430-6317
Mailing Address - Fax:325-430-6318
Practice Address - Street 1:2371 CROCKETT DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-430-6317
Practice Address - Fax:325-430-6318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRICK PROVIDER NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory