Provider Demographics
NPI:1992831689
Name:HINTON, MAURICE O (CRNA)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:O
Last Name:HINTON
Suffix:
Gender:M
Credentials:CRNA
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 23090
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3090
Mailing Address - Country:US
Mailing Address - Phone:601-968-1362
Mailing Address - Fax:601-292-4592
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-968-1362
Practice Address - Fax:601-292-4592
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR135040367500000X
IN23373367500000X
IN28232191A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992831689Medicaid
IN201389760Medicaid
IN000001052254OtherANTHEM PROVIDER NUMBER
MS00117027Medicaid
IN815500177Medicare PIN
MS00117027Medicaid