Provider Demographics
NPI:1245491026
Name:CHARLES W CADENHEAD M D
Entity type:Organization
Organization Name:CHARLES W CADENHEAD M D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CADENHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-864-2636
Mailing Address - Street 1:1417 NORTH 1ST ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-0938
Mailing Address - Country:US
Mailing Address - Phone:940-864-2636
Mailing Address - Fax:940-864-3009
Practice Address - Street 1:1417 NORTH 1ST ST SUITE A
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-0938
Practice Address - Country:US
Practice Address - Phone:940-864-2636
Practice Address - Fax:940-864-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4241261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063645801Medicaid
TX0049REOtherBLUE CROSS & BLUE SHIELD
TX1225468-01Medicaid
TXB21635Medicare UPIN
TX458940Medicare Oscar/Certification
TX613086Medicare PIN