MEDICARE: LARENE HARRIS HINTON

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	347C00000X	Private Vehicle	DL#007992433	SC

General Provider Information

NPI Number	:	1952538134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARENE HARRIS HINTON

Provider Business Mailing Address
First Line	:	1105 SEASIDE LN
Second Line	:	APT1
City	:	CHARLESTON
State	:	SC
Zip	:	29412-5300
Country	:	US
Telephone Number	:	843-406-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 SEASIDE LN
Second Line	:	APT1
City	:	CHARLESTON
State	:	SC
Zip	:	29412-5300
Country	:	US
Telephone Number	:	843-406-9407
Fax Number	:

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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