Provider Demographics
NPI:1841396835
Name:HINES, RALPH C (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:C
Last Name:HINES
Suffix:
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-326-4966
Mailing Address - Fax:270-326-4968
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-326-4966
Practice Address - Fax:270-326-4968
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15807207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044244OtherBCBS PROVIDER NUMBER
KY15807OtherLICENSE
KY64158074Medicaid
000000044244OtherBCBS PROVIDER NUMBER
KY460002648Medicare PIN
C64341Medicare UPIN
KY00280131Medicare PIN