MEDICARE: FREDERICK RANDOLPH HINSON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1033712682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK RANDOLPH HINSON

Provider Business Mailing Address
First Line	:	1208 RIVERSIDE LN
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4401
Country	:	US
Telephone Number	:	701-462-8489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 RIVERSIDE LN
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4401
Country	:	US
Telephone Number	:	701-462-8489
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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