=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407813967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN M HINER, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 11/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5671 E KETTLE PL
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-918-1012
-----------------------------------------------------
Fax | 720-529-3939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 173861
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80217-3861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-918-1012
-----------------------------------------------------
Fax | 720-529-3939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. JOHN HINER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-918-1012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------