Provider Demographics
NPI:1992988828
Name:MARK W. HINMAN, MD, LLC
Entity type:Organization
Organization Name:MARK W. HINMAN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:HINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-776-6872
Mailing Address - Street 1:1350 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3140
Mailing Address - Country:US
Mailing Address - Phone:303-776-6872
Mailing Address - Fax:303-776-2501
Practice Address - Street 1:1350 TULIP ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3140
Practice Address - Country:US
Practice Address - Phone:303-776-6872
Practice Address - Fax:303-776-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care