Healthcare Provider Details

I. General information

NPI: 1396400081
Provider Name (Legal Business Name): ANDREW HUTCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S 3RD ST
IRONTON OH
45638-1538
US

IV. Provider business mailing address

113 S 3RD ST
IRONTON OH
45638-1538
US

V. Phone/Fax

Practice location:
  • Phone: 740-744-1360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: