DR. MARK T HENDERSON (NPI# 1255372868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255372868 |
| Entity Type | Individual |
| Full Name | DR. MARK T HENDERSON |
| Credential | MD |
| Practice Address |
3607 Fern Valley Rd Ste 102 Louisville KY 40219-1916 |
| Practice Telephone | 5029648700 |
| Practice Fax Number | 5029648750 |
| Mailing Telephone | 5029648700 |
| Mailing Fax Number | 5029648750 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 33009 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | KENTUCKY LICENSE | 33009 | 01 |
| KY | 64330095 | 05 | |
| DEA | BH5591804 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639139876 | Mark Shea Henderson | Surgery | 135 Plaza Dr, Suite 202, Sikeston, MO 63801-5136 | 2006-03-23 |
| 1992792840 | Mark William Henderson | Dentist | 23d Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2005-10-05 |
| 1699245084 | Mark Henderson | Occupational Therapist | 28 Ritters Ridge Ct, Owings Mills, MD 21117-3355 | 2018-11-28 |
| 1760902498 | Mark E Henderson | Family Medicine | 4600 Valley Rd Ste 200, Lincoln, NE 68510-4882 | 2017-06-23 |
| 1407138167 | Mark Henderson | Pharmacist | 6958 Goodman Rd, Olive Branch, MS 38654-7034 | 2011-09-19 |
| 1184895856 | Mark C Henderson | Internal Medicine | 4860 Y St Ste 100, Sacramento, CA 95817-2307 | 2008-03-20 |
| 1912178229 | Mark Glen Henderson | Obstetrics & Gynecology | 2575 S Cimarron Rd, 102, Las Vegas, NV 89117-2682 | 2008-03-13 |
| 1841370707 | Mark A Henderson | Radiology | 2400 17th St, Columbus, IN 47201 | 2006-10-16 |
| 1891895272 | Mark Henderson | Internal Medicine | 900 Broadway, Bangor, ME 04401-1900 | 2006-09-25 |
| 1376562082 | Mark Reagan Henderson | Dentist | 5700 Arnold St, Tinker Afb, OK 73145-8105 | 2006-07-19 |
| Street Address |
3607 FERN VALLEY RD STE 102 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40219-1916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948154 | Kathleen B Berghausen | Nurse Practitioner | 4112 Fern Valley Rod, Louisville, KY 40219 | 2020-09-25 |
| 1174165989 | Joann Deborah Hobbs | Nurse Practitioner | 8216 Delido Rd, Louisville, KY 40219 | 2019-10-14 |
| 1962989319 | Jennifer Lynn Pinkerton | Hearing Instrument Specialist | 7326 Preston Hwy, Suite 206a, Louisville, KY 40219 | 2018-07-27 |
| 1942748447 | Melissa Freeman Emanuele | Speech-Language Pathologist | 1550 Raydale Drive, Lousville, KY 40219 | 2017-02-03 |
| 1083014013 | Christopher Maxey | Specialist/Technologist | Fern Valley Rd, Louisville, KY 40219 | 2014-08-27 |
| 1679985949 | Antwan Turner | Case Manager/Care Coordinator | 5523 Saxon Blvd, Louisville, KY 40219 | 2014-05-21 |
| 1386055168 | Kelly Larson | Case Manager/Care Coordinator | 6809 Bebe Ct., Louisville, KY 40219 | 2014-05-14 |
| 1639414626 | Prettysmilesdenturesandmorellc | Dentist | 19123 West Mcnichols Rd, Detroit, MI 40219 | 2012-12-03 |
| 1881967701 | Vickie Lynn Dixon | Homemaker | 3516 Templewood Dr., Louisville, KY 40219 | 2012-02-23 |
| 1811157555 | Tonya Lynn Frost | Chiropractor | 4300 Outer Loop Ste 10, Louisville, KY 40219 | 2008-06-16 |
| Find all providers in zip 40219 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316332448 | Christopher Fenzel | Emergency Medicine | 1850 Bluegrass Avenue, Louisville, KY 40215 | 2015-04-06 |
| 1477963163 | Tiffany A Campbell | Emergency Medicine | 530 South Jackson St., #c1h17, Louisville, KY 40202 | 2014-05-02 |
| 1154748382 | Samuel Rume Aya | Emergency Medicine | 530 South Jackson St, #c1h17, Department of Emergency Medicine, Louisville, KY 40202 | 2014-03-26 |
| 1598039315 | Mary Barbara Sowers | Emergency Medicine | 611 Emery Rd, Louisville, KY 40206 | 2012-02-24 |
| 1821383944 | Shaun M Reynolds | Emergency Medicine | 530 S Jackson St # C1h17, Department of Emergency Medicine, U of Louisville, Louisville, KY 40202-1675 | 2011-06-16 |
| 1497071674 | Jordan Taylor Brown | Emergency Medicine | 10904 Keene Rd, Louisville, KY 40241-4860 | 2010-04-14 |
| 1366679342 | Devin Sandlin | Emergency Medicine | 1907 Stevens Ave, Louisville, KY 40205-1048 | 2009-06-17 |
| 1801023320 | Mark Timothy Scallon Rukavina | Emergency Medicine | 2400 Mellwood Ave, Apt 1003, Louisville, KY 40206-1061 | 2009-06-11 |
| 1962664961 | Amy Lynn Minix | Emergency Medicine | 3504 Birchmore Pl, Louisville, KY 40245-8475 | 2008-06-30 |
| 1912169673 | Valerie King | Emergency Medicine | 2779 Maple Rd, Louisville, KY 40205-1735 | 2008-06-25 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40219 |
Please comment or provide details below to improve the information on DR. MARK T HENDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.