Provider Demographics
NPI:1437101128
Name:HENDRIX, JR., CHARLES E (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:HENDRIX, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4853
Mailing Address - Country:US
Mailing Address - Phone:812-885-3325
Mailing Address - Fax:812-885-8499
Practice Address - Street 1:700 WILLOW ST STE 202
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1029
Practice Address - Country:US
Practice Address - Phone:812-885-0520
Practice Address - Fax:812-885-0517
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030371A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154890Medicaid
IN118323OtherHEALTHLINK
INP00851310OtherRAILROAD MEDICARE
INM400017673Medicare PIN
IN100154890Medicaid
IN941140N4Medicare PIN
IN118323OtherHEALTHLINK
IN100154890AMedicaid
IND69630Medicare UPIN