MEDICARE: DR. RONALD WAYNE HINES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	113	OK
2	213E00000X	Podiatrist	2012014963	MO
3	213E00000X	Podiatrist	12-00387	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731130289001	OTHER	OK	BLUE CROSS BLUE SHIELD
2	1295773398	OTHER	OK	GROUP NPI
3	0764240001	OTHER	OK	DMERC

General Provider Information

NPI Number	:	1023011616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WAYNE HINES DPM

Provider Business Mailing Address
First Line	:	4513 W 124TH LN
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-2603
Country	:	US
Telephone Number	:	405-659-1842
Fax Number	:	913-261-9255

Provider Business Practice Location Address
First Line	:	4513 W 124TH LN
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-2603
Country	:	US
Telephone Number	:	405-659-1842
Fax Number	:	913-261-9255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/11/2013

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