MEDICARE: DR. ELBERT EDWIN HINES III M.D.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD15653	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080040881	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2008944	OTHER	TN	BLUECROSS&BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801896881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELBERT EDWIN HINES III M.D.

Provider Business Mailing Address
First Line	:	6263 POPLAR AVE
Second Line	:	STE 1052
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4736
Country	:	US
Telephone Number	:	901-761-6157
Fax Number	:	901-761-4145

Provider Business Practice Location Address
First Line	:	6263 POPLAR AVE
Second Line	:	STE 1052
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4736
Country	:	US
Telephone Number	:	901-761-6157
Fax Number	:	901-213-4513

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	05/06/2016

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