1013070515 NPI number — DR. EDWARD L HINES MD

Table of content: DR. EDWARD L HINES MD (NPI 1013070515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013070515 NPI number — DR. EDWARD L HINES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
EDWARD
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013070515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1236 HUFFMAN MILL RD
Provider Second Line Business Mailing Address:
SUITE1300
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27215-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-584-5544
Provider Business Mailing Address Fax Number:
336-584-4438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 HUFFMAN MILL RD
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-584-5544
Provider Business Practice Location Address Fax Number:
336-584-4438
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  20607 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42508 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8942508 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4337 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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