Basic Information
| Provider Information | |||||||||
| NPI: | 1841295904 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENDERSON EMERGENCY PHYSICIANS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3114 CROASDAILE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194251565 | ||||||||
| FaxNumber: | 9194250478 | ||||||||
| Practice Location | |||||||||
| Address1: | 566 RUIN CREEK RD | ||||||||
| Address2: | HENDERSON EMERGENCY PHYSICIANS | ||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275362927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524384143 | ||||||||
| FaxNumber: | 9194250478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 05/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8777511157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 19725 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5901370 | 05 | NC | MEDICAID |