Healthcare Provider Details

I. General information

NPI: 1851060248
Provider Name (Legal Business Name): BERT HUTCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6547 BERKEY SOUTHERN RD
WHITEHOUSE OH
43571-9608
US

IV. Provider business mailing address

6547 BERKEY SOUTHERN RD
WHITEHOUSE OH
43571-9608
US

V. Phone/Fax

Practice location:
  • Phone: 419-346-9557
  • Fax:
Mailing address:
  • Phone: 419-346-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: