Provider Demographics
NPI:1992730915
Name:HINES, HENRY CASEY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CASEY
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:PO BOX 145
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF MURRAY
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-0145
Mailing Address - Country:US
Mailing Address - Phone:270-759-1805
Mailing Address - Fax:859-223-2732
Practice Address - Street 1:803 POPLAR ST
Practice Address - Street 2:MURRAY-CALLOWAY COUNTY HOSPITAL
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-759-1805
Practice Address - Fax:859-223-2732
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64246242Medicaid
KY1283503Medicare ID - Type Unspecified
KY64246242Medicaid