Basic Information
| Provider Information | |||||||||
| NPI: | 1295728152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCHENRY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LIONEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HOSPITAL DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414895 | ||||||||
| FaxNumber: | 9036414894 | ||||||||
| Practice Location | |||||||||
| Address1: | 3124 W HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414270 | ||||||||
| FaxNumber: | 9038725321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F6929 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100075403 | 05 | TX | MEDICAID | 8G9847 | 01 | TX | BLUE CROSS | OTHER |