Provider Demographics
NPI:1447335443
Name:DRS. HENRY, KINDER & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:DRS. HENRY, KINDER & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-388-7130
Mailing Address - Street 1:600 MORRIS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1409
Mailing Address - Country:US
Mailing Address - Phone:304-388-7130
Mailing Address - Fax:304-388-7136
Practice Address - Street 1:600 MORRIS ST STE 102
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1409
Practice Address - Country:US
Practice Address - Phone:304-388-7130
Practice Address - Fax:304-388-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006099Medicaid
WV3810006099Medicaid