Provider Demographics
NPI:1184779381
Name:THE HINDS MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:THE HINDS MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:731-587-3454
Mailing Address - Street 1:215 HAWKS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2708
Mailing Address - Country:US
Mailing Address - Phone:731-587-3454
Mailing Address - Fax:731-587-3460
Practice Address - Street 1:215 HAWKS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2708
Practice Address - Country:US
Practice Address - Phone:731-587-3454
Practice Address - Fax:731-587-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723237Medicaid
TNDC4358OtherRAILROAD MEDICARE
TN3723237Medicare PIN