Provider Demographics
NPI:1841226792
Name:HINES, BRUCE E (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
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 1:1 VANTAGE WAY
Mailing Address - Street 2:SUITE B240
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1515
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-327-4403
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3837
Practice Address - Country:US
Practice Address - Phone:800-596-3455
Practice Address - Fax:615-396-6963
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30050207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64028517OtherKY MEDICAID
TN3137181OtherBLUECROSS
TN3825882Medicaid
TN3127190OtherSTONES RIVER IPA
KY64028517OtherKY MEDICAID
TNG56303Medicare UPIN