# MA HENDRICKSON DO PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588615223
- **Authorized official:** M ALLISON HENDRICKSON DO (OWNER)
- **Authorized official phone:** (817) 284-4081

## Contact information

- **Practice address:** 4109 CAGLE DR, SUITE B, NORTH RICHLAND HILLS, TX 76180-8339
- **Practice address phone:** (817) 284-4081
- **Practice address fax:** (817) 284-3988
- **Mailing address:** 4109 CAGLE DR, SUITE B, NORTH RICHLAND HILLS, TX 76180-8339
- **Mailing address phone:** (817) 284-4081
- **Mailing address fax:** (817) 284-3988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2006
- **Last updated:** 08/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0064MA | BCBS GROUP NUMBER | TX |
| 01 | — | 110208679 | MEDICARE RR GROUP NUMBER | — |
| 05 | — | 172016101 | — | TX |