Interstate Clinic LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

INTERSTATE CLINIC LLC

Practice address

210 N Bosque St
Whitney, TX 76692-2416

Phone

(254) 221-4342

Fax

(254) 221-7051

NPI assigned

Feb 10, 2020

Organization subpart

No

Name

Dr. Randall Dale Henderson, DO

Title

Owner

Phone

(254) 707-0095

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 27, 2020.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1003448770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1400",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766921400",
            "telephone_number": "254-707-0095",
            "fax_number": "800-257-1471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N BOSQUE ST",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766922416",
            "telephone_number": "254-221-4342",
            "fax_number": "254-221-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERSTATE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "254-707-0095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bailey E Kudrna, COTA/L
• Lake Whitney Home Health Services

• All providers in Whitney, TX
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.