DR. VINCENT CHARLES HENDERSON M.D. NPI 1275521452

NPI Information

NPI: 1275521452
Provider Name: DR. VINCENT CHARLES HENDERSON, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Address:
3575 PORTAGE RD
SOUTH BEND, IN
ZIP 46628
Phone: (574) 647-4530
Get Directions

DR. Vincent Charles Henderson, M.D. is a family medicine in South Bend, IN. The provider is 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. DR. Vincent Charles Henderson, M.D. NPI is 1275521452. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3575 PORTAGE RD
SOUTH BEND, IN
ZIP 46628-092
Phone: (574) 647-4530
Fax: (574) 647-4531

The enumeration date for this NPI number is 10/11/2005 and was last updated on 3/17/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		01033656A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000085144	OTHER	INDIANA	BCBS BMG MAIN ST
2	000000588530	OTHER	INDIANA	BCBS BMG E BLAIR WARNER
3	236040MM	MEDICARE PIN	INDIANA
4	200064640	MEDICAID	INDIANA
5	000000085145	OTHER	INDIANA	BCBS BMG MEDPOINT IRELAND
6	000000319907	OTHER	INDIANA	BCBS BMG PORTAGE RD
7	M400039250	MEDICARE PIN	INDIANA
8	236040A	MEDICARE PIN	INDIANA
9	080073934	OTHER	INDIANA	RR MEDICARE
10	E56426	MEDICARE UPIN	INDIANA
11	247000B	MEDICARE PIN	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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