Healthcare Provider Details

I. General information

NPI: 1760626147
Provider Name (Legal Business Name): HINTON HEALTHCARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ SUITE 230
LAKE ST LOUIS MO
63367-1481
US

IV. Provider business mailing address

17204 LAFAYETTE TRAILS DR
WILDWOOD MO
63038-1386
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-1111
  • Fax: 636-625-8566
Mailing address:
  • Phone: 636-898-1082
  • Fax: 636-625-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006003131
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006003131
License Number StateMO

VIII. Authorized Official

Name: DR. PAUL ANTHONY HINTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-369-9061