DR. EDWARD DANIEL HENDERSON JR. (NPI# 1346222890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346222890 |
| Entity Type | Individual |
| Full Name | DR. EDWARD DANIEL HENDERSON JR. |
| Credential | M.D. |
| Practice Address |
9097 Collinsville Rd Collinsville MS 39325-9779 |
| Mailing Address |
Po Box 2106 Meridian MS 39302-2106 |
| Practice Telephone | 6016268874 |
| Practice Fax Number | 6016268592 |
| Mailing Telephone | 6017034282 |
| Mailing Fax Number | 6017034597 |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2013-11-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 16698 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00121878 | 05 | |
| BLUE CROSS OF AL | 730-14734 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821380189 | Edward Money Henderson | Pediatrics | 866 Kygers Hill Rd, Lexington, VA 24450-6913 | 2011-05-05 |
| 1952639130 | Edward Alan Henderson | Contractor | 33020 16th Pl Sw, Federal Way, WA 98023-6461 | 2009-11-25 |
| 1326237447 | Edward Bruce Henderson | Social Worker | 939 W Sunnyside Ave, #1w, Chicago, IL 60640-6967 | 2007-10-15 |
| Street Address |
9097 COLLINSVILLE RD |
| City | COLLINSVILLE |
| State | MS |
| Zip Code | 39325-9779 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689096505 | Wendy D Gressett | Nurse Practitioner | 9097 Collinsville Rd, Collinsville, MS 39325-9779 | 2014-01-11 |
| 1073959375 | Laird Hospital, Inc | Family Medicine | 9097 Collinsville Rd, Collinsville, MS 39325-9779 | 2013-05-14 |
| 1104115500 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 9097 Collinsville Rd, Collinsville, MS 39325-9779 | 2011-04-06 |
| 1578796462 | Rush Care, Inc. | Clinic/Center | 9097 Collinsville Rd, Collinsville, MS 39325-9779 | 2009-08-26 |
| 1245213354 | Gloria J. Jackson | Nurse Practitioner | 9097 Collinsville Rd, Collinsville, MS 39325-9779 | 2005-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033609409 | Anna Victoria Stewart | Speech-Language Pathologist | 11790 Pine Grove Rd, Collinsville, MS 39325 | 2018-05-11 |
| 1083160782 | Chandra Sumlin-brown Dba Sumlin Behavioral Services | Psychiatric Hospital | 8237b Okatibbee Dam Road, Collinsville, MS 39325 | 2016-09-01 |
| 1982948980 | Lisa Wiliams | Registered Nurse | 8237 A Okatibbee Dam Rd, Collinsville, MS 39325 | 2012-11-15 |
| 1770883688 | Collinsville Family Dental | Dentist | 9171 A, Old Hwy 19n, Collinsville, MS 39325 | 2010-10-26 |
| 1942550280 | Adam Turbyfill | Pharmacist | 9155 Hwy 19, Collinsville, MS 39325-0175 | 2012-09-13 |
| 1811001878 | Collinsville Drugs Inc | Pharmacy | 9158 Hwy 19, Collinsville, MS 39325-0175 | 2006-08-18 |
| 1184238396 | Veronica Necole Mcfadden | Student in an Organized Health Care Education/Training Program | 8583 Wilsondale Rd, Collinsville, MS 39325-8957 | 2020-09-04 |
| 1659688422 | Oya Weston Hampton | Counselor | 9056b Collinsville Rd, Collinsville, MS 39325-9100 | 2010-09-01 |
| 1801997606 | Tammy N Henderson | General Practice | 9325c Highway 19 N, Collinsville, MS 39325-9219 | 2006-09-26 |
| 1477642791 | Kid's Clinic, Pllc | General Practice | 9325c Highway 19 N, Collinsville, MS 39325-9219 | 2006-10-12 |
| Find all providers in zip 39325 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205361110 | Pc Associates, LLC | Family Medicine | 1095 Beltline Road, Suite 500, Collinsville, IL 62234 | 2017-04-28 |
| 1982917183 | Pc Associates, LLC | Family Medicine | 501 Beltline Road, Ste 20-d, Collinsville, IL 62234-4410 | 2010-07-16 |
| 1669566527 | Frances H. Koe | Family Medicine | 52 S Valley Ave, Collinsville, AL 35961-3263 | 2006-10-03 |
| 1194749218 | Patrick Zimmermann | Family Medicine | 531 Vandalia St, Suite 100, Collinsville, IL 62234-4061 | 2006-07-26 |
| 1477506426 | Joseph Michael Corvallis | Family Medicine | 101 Saint Louis Rd, Collinsville, IL 62234-2450 | 2006-05-19 |
| 1801890454 | Jerry D. Patton | Family Medicine | 1205 W Main St, Collinsville, OK 74021-3114 | 2005-06-10 |
| 1902450281 | Pamela Shirley | Family Medicine | 52 S Valley Ave Ste B, Collinsville, AL 35961-3263 | 2019-07-25 |
| 1013432244 | Fort Payne Rhc Corp | Family Medicine | 13280 County Road 51, Collinsville, AL 35961-4174 | 2017-08-09 |
| 1073035051 | Fort Payne Clinic Corp | Family Medicine | 13280 County Road 51, Collinsville, AL 35961-4174 | 2017-07-12 |
| 1508218959 | Constance Rogers | Family Medicine | 1205 W Main St, Collinsville, OK 74021 | 2016-07-11 |
| Find all providers in COLLINSVILLE | ||||
| City | COLLINSVILLE |
| Zip Code | 39325 |
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| 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.