Healthcare Provider Details

I. General information

NPI: 1275854259
Provider Name (Legal Business Name): MELISSA RUTH HINES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL # MS 734 DIVISION OF PEDIATRIC CRITICAL CARE
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PL # MS 734 DIVISION OF PEDIATRIC CRITICAL CARE
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3668
  • Fax:
Mailing address:
  • Phone: 901-595-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54258
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number54258
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: