Provider Demographics
NPI:1083758122
Name:E E HINES III MD, PC
Entity Type:Organization
Organization Name:E E HINES III MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HINES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-6157
Mailing Address - Street 1:3665 ELLEN DAVIES CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-0940
Mailing Address - Country:US
Mailing Address - Phone:901-849-7065
Mailing Address - Fax:901-213-4513
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:STE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:901-761-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
002008944OtherBLUE CROSS BLUE SHIELD
TNCL0583OtherRAILROAD MEDICARE
4409209005OtherCIGNA
TN3389063Medicaid
4409209005OtherCIGNA
3389063Medicare PIN