Healthcare Provider Details

I. General information

NPI: 1750878799
Provider Name (Legal Business Name): HUTCHISON ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16561 N COUNTY FARM LN
MOUNT VERNON IL
62864-7934
US

IV. Provider business mailing address

16561 N COUNTY FARM LN
MOUNT VERNON IL
62864-7934
US

V. Phone/Fax

Practice location:
  • Phone: 618-231-1324
  • Fax:
Mailing address:
  • Phone: 618-231-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN HUTCHISON
Title or Position: MEMBER
Credential:
Phone: 618-231-1324