| Kenneth Hines Md Pa | |
|
408 W Market St Greenwood MS 38930 | |
| (662) 455-1442 | |
| (662) 455-6065 |
| Full Name | Kenneth Hines Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 408 W Market St, Greenwood, Mississippi |
| Authorized Official Name and Position | Kenneth Lee Hines (PRESIDENT 100 PERCENT STOCKHOLDER) |
| Authorized Official Contact | 6624551442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Hines Md Pa 408 W Market St Greenwood MS 38930 Ph: (662) 455-1442 | Kenneth Hines Md Pa 408 W Market St Greenwood MS 38930 Ph: (662) 455-1442 |
| NPI Number | 1972689321 |
|---|---|
| Provider Enumeration Date | 10/28/2006 |
| Last Update Date | 11/07/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972689321 | NPI | - | NPPES |
| 09016211 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 08354 (Mississippi) | Primary |
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