Organization Active NPI

Henderson Podiatry, LLC

  • Podiatrist
  • Lancaster, PA
National Provider Identifier
1437347150
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SC002642L Issued in PA
Legal business name
HENDERSON PODIATRY, LLC
Practice address
882 Millersville Rd
Lancaster, PA 17603
Phone
(717) 291-0391
Fax
(717) 291-0832
NPI assigned
Oct 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Authorized official

Name
Marilyn C Henderson, DPMNPI 1245201789
Title
Owner
Phone
(717) 291-0391

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X SC002642L PA Primary

Addresses

Primary practice location

882 Millersville Rd
Lancaster, PA 17603

Mailing address

882 Millersville Rd
Lancaster, PA 17603-6154
Phone (717) 291-0391

Other identifiers 1

IdentifierTypeStateIssuer
480033950OtherPARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180612000860 PA Part B Supplier - Clinic/Group Practice 3971858184 Receives reassigned benefits from 3 practitioners
Practice locations: Lancaster, PA; Willow Street, PA
O20181030001021 PA DME Supplier - Physician - Podiatry 3971858184 Practice locations: Lancaster, PA

National Provider Directory

National Provider Directory

Locations

882 Millersville Rd
Lancaster, PA 17603
Phone (717) 291-0391

324 Beaver Valley Pike
Willow Street, PA 17584
Phone (717) 291-0391

324 Beaver Valley Pike
Ste 1
Willow Street, PA 17584
Phone (717) 464-5603

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527811200000",
    "number": "1437347150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "882 MILLERSVILLE RD",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176036154",
            "telephone_number": "717-291-0391",
            "fax_number": "717-291-0832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "882 MILLERSVILLE RD",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "17603",
            "telephone_number": "717-291-0391",
            "fax_number": "717-291-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2018-06-01",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-291-0391",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC002642L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480033950",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.