Provider Demographics
NPI:1902976327
Name:STEVEN R HENDRICKS, DO, PC
Entity Type:Organization
Organization Name:STEVEN R HENDRICKS, DO, PC
Other - Org Name:STEVEN R HENDRICKS, DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-962-2922
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:44 VESPER STREET
Mailing Address - City:BEECH CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16822-0430
Mailing Address - Country:US
Mailing Address - Phone:570-962-2922
Mailing Address - Fax:570-962-2944
Practice Address - Street 1:44 VESPER STREET
Practice Address - Street 2:BOX 430
Practice Address - City:BEECH CREEK
Practice Address - State:PA
Practice Address - Zip Code:16822-0430
Practice Address - Country:US
Practice Address - Phone:570-962-2922
Practice Address - Fax:570-962-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007225-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty