Provider Demographics
NPI:1922219880
Name:KEVIN R. HILTON, M.D., INC.
Entity Type:Organization
Organization Name:KEVIN R. HILTON, M.D., INC.
Other - Org Name:CALIFORNIA SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-781-9101
Mailing Address - Street 1:1420 E ROSEVILLE PKWY STE 140355
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3078
Mailing Address - Country:US
Mailing Address - Phone:916-781-9101
Mailing Address - Fax:916-781-9102
Practice Address - Street 1:576 N SUNRISE AVE STE 230A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2847
Practice Address - Country:US
Practice Address - Phone:916-781-9101
Practice Address - Fax:916-781-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079838207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31056ZMedicare PIN
CAG75181Medicare UPIN