Henderson, Mark Shea

Henderson, Mark Shea is an individual health care provider with primary practice located at 135 Plaza Dr Suite 202, Sikeston MO 63801-5136. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Henderson, Mark Shea can be contacted via phone (573) 472-6003.

Contact Information

Primary practice address
135 Plaza Dr Suite 202 Sikeston MO 63801-5136
Phone: (573) 472-6003
Fax: (573) 472-7159
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X J4200 Texas

Profile Details

NPI number 1639139876
LBN Legal business name Henderson, Mark Shea
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2006
Last updated Jan 24th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639139876 NPPES
Texas Other 8BF145 BCBS
Texas MEDICAID 113358901 BCBS
Texas MEDICAID 113358905 BCBS
Texas MEDICAID 113358906 BCBS
Texas MEDICAID 113358907 BCBS
Texas Other 990010000 BCBS

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