Provider Demographics
NPI:1851508949
Name:HEALTHSOUTH MEN'S CLINIC
Entity Type:Organization
Organization Name:HEALTHSOUTH MEN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-483-4938
Mailing Address - Street 1:3637 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-483-4938
Mailing Address - Fax:910-483-3094
Practice Address - Street 1:3637 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-483-4938
Practice Address - Fax:910-483-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8942514Medicaid
NC42514OtherBCBS-DR HINES
NC5906149Medicaid
NC4665208OtherAETNA DR SALCEDO
NCC62354Medicare UPIN
NC2332734Medicare ID - Type UnspecifiedDR HINES
NC8942514Medicaid