Provider Demographics
NPI:1407813967
Name:JOHN M HINER, MD, PLLC
Entity type:Organization
Organization Name:JOHN M HINER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-918-1012
Mailing Address - Street 1:PO BOX 173861
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3861
Mailing Address - Country:US
Mailing Address - Phone:303-918-1012
Mailing Address - Fax:720-529-3939
Practice Address - Street 1:5671 E KETTLE PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2458
Practice Address - Country:US
Practice Address - Phone:303-918-1012
Practice Address - Fax:720-529-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17889081Medicaid
CO17889081Medicaid