Provider Demographics
NPI:1528034881
Name:SCOTTY WAYNE HINSON
Entity Type:Organization
Organization Name:SCOTTY WAYNE HINSON
Other - Org Name:FAITH MEDICAL SUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTTY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-485-3125
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:125 W. THIRD ST.
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-0690
Mailing Address - Country:US
Mailing Address - Phone:704-485-3125
Mailing Address - Fax:704-485-2662
Practice Address - Street 1:125 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKBORO
Practice Address - State:NC
Practice Address - Zip Code:28129
Practice Address - Country:US
Practice Address - Phone:704-485-3125
Practice Address - Fax:704-485-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703689Medicaid
SCDM1112Medicaid
NC4586790001Medicare NSC