NPIMap

Organization Active NPI

Hendricks Clinic PA

  • Family Medicine Physician
  • Hendricks, MN
National Provider Identifier
1104850510
Registry record updated Dec 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HENDRICKS CLINIC PA
Practice address
501 E Lincoln St
Hendricks, MN 56136-0026
Phone
(507) 275-3121
Fax
(507) 275-3194
NPI assigned
Jul 10, 2006
Last updated
Dec 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tabb L McCluskey, DONPI 1952336828
Title
Owner President
Phone
(507) 275-3121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Rural Health Clinic/Center 261QR1300X 1757969 MN

Addresses

Primary practice location

501 E Lincoln St
Hendricks, MN 56136-0026

Mailing address

501 E Lincoln St
PO Box 26
Hendricks, MN 56136-0026
Phone (507) 275-3121

Other identifiers 1

IdentifierTypeStateIssuer
232816000MedicaidMN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1104850510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 E LINCOLN ST",
            "address_2": "PO BOX 26",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561360026",
            "telephone_number": "507-275-3121",
            "fax_number": "507-275-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E LINCOLN ST",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561360026",
            "telephone_number": "507-275-3121",
            "fax_number": "507-275-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "MCCLUSKEY",
        "authorized_official_first_name": "TABB",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "507-275-3121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MN",
            "license": "1757969",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232816000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendricks, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; 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.