Provider Demographics
NPI:1336364215
Name:JACK TERRELL HINKLE DO PC
Entity Type:Organization
Organization Name:JACK TERRELL HINKLE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-628-5851
Mailing Address - Street 1:595 S BLUFF ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3593
Mailing Address - Country:US
Mailing Address - Phone:435-628-5851
Mailing Address - Fax:435-628-5852
Practice Address - Street 1:595 S BLUFF ST STE 6
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3593
Practice Address - Country:US
Practice Address - Phone:435-628-5851
Practice Address - Fax:435-628-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4903985-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE89385Medicare UPIN
UT0P43850Medicare PIN