Mark A. Hendley, CASE MANAGER
Individual provider Active NPI Specialist · Raton, NM
NPI 1104988153 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104988153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 220 4TH Ave
Raton, NM 87740-2643 - Phone
- (505) 445-2754
- Fax
- (505) 445-2225
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
220 4TH Ave
Raton, NM 87740-2643
Mailing address
136 Canyon Dr
Raton, NM 87740-3756
Phone (505) 445-2754
Other providers in Raton, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.