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General NPI Number Information
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NPI Number | 1114891074
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Entity Type | Organization
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Legal Business Name | HINES ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 2020 S JOHNS AVE STE B
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City | EMMETT
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State | ID
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Zip | 83617-1386
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Country | US
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Telephone | 208-817-2663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | EMMETT
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State | ID
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Zip | 83617-0128
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Country | US
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Telephone | 208-817-2663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROD L HINES
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Credential | MD
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Telephone | 208-954-1762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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