Mena Internal Medicine

Primary specialty

SpecialistTaxonomy code 174400000X

License

E3000 Issued in AR

Legal business name

MENA INTERNAL MEDICINE

Practice address

531 Polk 77
Mena, AR 71953-7848

Phone

(479) 437-3602

Fax

(479) 437-3604

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David Henderson, MD

Title

Owner

Phone

(479) 437-3602

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250208000000",
    "number": "1194846873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 POLK 77",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719537848",
            "telephone_number": "479-437-3602",
            "fax_number": "479-437-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 POLK 77",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719537848",
            "telephone_number": "479-437-3602",
            "fax_number": "479-437-3604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENA INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2009-08-14",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-437-3602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "E3000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145341002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mena Hospital Commission
• Mena Hospital Commission
• Mena Hospital Commission
• Mena Hospital Commission
• Mena Hospital Commission
• Mena Medical Center Home Health, LLC
• Mena Medical Center Hospice, LLC
• Mena Pediatric Center, PLLC
• Mena Public Schools
• Mena Regional Health System Pharmacy

• Specialist in Mena, AR
• Providers in Mena, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.