Provider Demographics
NPI:1902909559
Name:HUTCHINSON CLINIC INC
Entity Type:Organization
Organization Name:HUTCHINSON CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-258-2536
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628
Mailing Address - Country:US
Mailing Address - Phone:660-258-2536
Mailing Address - Fax:660-258-3719
Practice Address - Street 1:624 W LOCKLING AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628
Practice Address - Country:US
Practice Address - Phone:660-258-2536
Practice Address - Fax:660-258-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO30110207K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS0568OtherRAILROAD MEDICARE