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John C Hendricks

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

75 Sheldon Blvd SE, Suite 100, Grand Rapids, MI 49503

PECOS Enrollment

This provider is enrolled in PECOS as JOHN HENDRICKS.

Based on the most recent information from CMS, provider John C Hendricks is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 10:37 AM.

Profile Details

Provider ID
1992705610
Provider Type
Individual
Full Name
Hendricks, John C
Title
Mr.
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
7/22/2005
Last Updated
1/3/2014

Contact Information

Practice Location

75 Sheldon Blvd SE, Suite 100, Grand Rapids, MI 49503

(616) 391-6120

(616) 391-6125

Mailing Location

100 Michigan St NE, Mc 845, Grand Rapids, MI 49503

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 5601001665 Michigan

John C Hendricks

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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