MEDICARE: MR. FREDERICK R. HINZE HSP-PA

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	101Y00000X	Counselor	1303	NC
2	103T00000X	Psychologist	1303	NC

General Provider Information

NPI Number	:	1104014851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDERICK R. HINZE HSP-PA

Provider Business Mailing Address
First Line	:	1440 OLD LENOIR RD STE B
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2489
Country	:	US
Telephone Number	:	828-328-9600
Fax Number	:	828-261-0576

Provider Business Practice Location Address
First Line	:	219A AVERY AVE
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3102
Country	:	US
Telephone Number	:	828-430-4388
Fax Number	:	828-430-4384

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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