| E E Hines III MD, PC | |
|
6263 Poplar Ave Ste 1052 Memphis TN 38119-4701 | |
| (901) 761-6157 | |
| (901) 761-4145 |
| Full Name | E E Hines III MD, PC |
|---|---|
| Speciality | Family Medicine |
| Location | 6263 Poplar Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Elbert E. Hines (PRESIDENT) |
| Authorized Official Contact | 9017616157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| E E Hines III MD, PC 3665 Ellen Davies Cv Bartlett TN 38133-0940 Ph: (901) 849-7065 | E E Hines III MD, PC 6263 Poplar Ave Ste 1052 Memphis TN 38119-4701 Ph: (901) 761-6157 |
| NPI Number | 1083758122 |
|---|---|
| Provider Enumeration Date | 02/19/2007 |
| Last Update Date | 02/11/2015 |
| Medicare PECOS PAC ID | 8224175245 |
|---|---|
| Medicare Enrollment ID | O20091023000546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083758122 | NPI | - | NPPES |
| 002008944 | Other | BLUE CROSS BLUE SHIELD | |
| 3389063 | Medicaid | TN | |
| 4409209005 | Other | CIGNA | |
| CL0583 | Other | TN | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (NU) | Primary |
| Provider Name | Elbert E Hines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801896881 PECOS PAC ID: 3274426093 Enrollment ID: I20040615000325 |
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