Provider Demographics
NPI:1053716340
Name:KENDRA VERHELLE MD COMMUNITY MEDICAL CARE PA
Entity type:Organization
Organization Name:KENDRA VERHELLE MD COMMUNITY MEDICAL CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VERHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-683-6619
Mailing Address - Street 1:163 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1217
Mailing Address - Country:US
Mailing Address - Phone:903-683-6619
Mailing Address - Fax:903-683-1176
Practice Address - Street 1:163 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1217
Practice Address - Country:US
Practice Address - Phone:903-683-6619
Practice Address - Fax:903-683-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty