1619947215 NPI number — DR. SUSAN JEAN HINES

Table of content: DR. SUSAN JEAN HINES (NPI 1619947215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619947215 NPI number — DR. SUSAN JEAN HINES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
SUSAN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1619947215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1908 CAUDLE DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-4322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-783-6935
Provider Business Practice Location Address Fax Number:
336-783-6934
Provider Enumeration Date:
01/25/2006

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: 207RX0202X , with the licence number:  2000-00229 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 2000-00229 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 89126FM , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37156 . This is a "PARTNERS NATIONAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006005306 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126FM . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 900004457 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4474243 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3097131 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3608287 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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