Provider Demographics
NPI:1336141670
Name:HINES, THOMAS RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDALL
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4169
Mailing Address - Country:US
Mailing Address - Phone:806-677-0500
Mailing Address - Fax:806-677-0860
Practice Address - Street 1:25 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-677-0500
Practice Address - Fax:806-677-0860
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025LEOtherBLUE CROSS OF TEXAS
TX11518101OtherFIRST CARE/SW LIFE
TX164624201Medicaid
TX200172742OtherHUMANA MILITARY
TX164624202Medicaid
TX164624202Medicaid
TXH12637Medicare UPIN
TX00554WMedicare ID - Type UnspecifiedMCARE