Healthcare Provider Details

I. General information

NPI: 1679505416
Provider Name (Legal Business Name): HUTCHINSON AREA HC ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HIGHWAY 15 S
HUTCHINSON MN
55350-5000
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 320-234-4603
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: PHIL GRAVES
Title or Position: PRESIDENT
Credential:
Phone: 952-442-9770