Provider Demographics
NPI:1679671929
Name:HINES FAMILY CARE CENTER INC
Entity Type:Organization
Organization Name:HINES FAMILY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ELVIS
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-830-1900
Mailing Address - Street 1:13300 NEW HALLS FERRY RD
Mailing Address - Street 2:STE C
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3251
Mailing Address - Country:US
Mailing Address - Phone:314-830-1900
Mailing Address - Fax:314-830-4530
Practice Address - Street 1:13300 NEW HALLS FERRY RD
Practice Address - Street 2:STE C
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3251
Practice Address - Country:US
Practice Address - Phone:314-830-1900
Practice Address - Fax:314-830-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4G28207Q00000X
MI4301050425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty