Provider Demographics
NPI: | 1861489635 |
---|---|
Name: | HINES, ROBERT STEPHEN SR (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ROBERT |
Middle Name: | STEPHEN |
Last Name: | HINES |
Suffix: | SR |
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: | PO BOX 743070 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30374-3070 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-560-4304 |
Mailing Address - Fax: | 864-560-4413 |
Practice Address - Street 1: | 1190 FILBERT HWY STE 110 |
Practice Address - Street 2: | |
Practice Address - City: | YORK |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29745-9324 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-628-0004 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-05 |
Last Update Date: | 2018-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 16452 | 207Q00000X, 2083X0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 164529 | Medicaid | |
SC | F706686067 | Medicare PIN | |
SC | F70668 | Medicare UPIN | |
SC | 4144 | Medicare PIN |