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NPI Code Detail

MEDICARE: JOHN L HINES MD

MEDICARE: JOHN L HINES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician0101043707VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316942253
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN L HINES MD
Provider Business Mailing Address
First Line : PO BOX 1789
Second Line :
City : ROANOKE
State : VA
Zip : 24008-1789
Country : US
Telephone Number : 540-855-5100
Fax Number :
Provider Business Practice Location Address
First Line : 5296 PETERS CREEK RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-3808
Country : US
Telephone Number : 540-855-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 02/04/2010

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