=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336364215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACK TERRELL HINKLE DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 12/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 S BLUFF ST STE 6
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84770-3593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-628-5851
-----------------------------------------------------
Fax | 435-628-5852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 S BLUFF ST STE 6
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84770-3593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-628-5851
-----------------------------------------------------
Fax | 435-628-5852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO
-----------------------------------------------------
Name | DR. JACK HINKLE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 435-628-5851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4903985-1204
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------