MEDICARE: WILLIAM EDWARD HINMAN PA-C

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
1	363A00000X	Physician Assistant	84	NE
2	207Q00000X	Family Medicine Physician	84	NE

General Provider Information

NPI Number	:	1770579088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EDWARD HINMAN PA-C

Provider Business Mailing Address
First Line	:	721 W 6TH AVENUE
Second Line	:
City	:	RED CLOUD
State	:	NE
Zip	:	68970
Country	:	US
Telephone Number	:	402-746-5614
Fax Number	:	402-746-5684

Provider Business Practice Location Address
First Line	:	721 W 6TH AVENUE
Second Line	:
City	:	RED CLOUD
State	:	NE
Zip	:	68970
Country	:	US
Telephone Number	:	402-746-5614
Fax Number	:	402-746-5684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	09/29/2011

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