Provider Demographics
NPI:1306419197
Name:HINES, STEVEN WAYNE
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:HINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14531 OLD NASHVILLE HWY APT 8301
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6644
Mailing Address - Country:US
Mailing Address - Phone:615-295-7194
Mailing Address - Fax:
Practice Address - Street 1:14531 OLD NASHVILLE HWY APT 8301
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6644
Practice Address - Country:US
Practice Address - Phone:615-295-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)