Healthcare Provider Details

I. General information

NPI: 1104956192
Provider Name (Legal Business Name): JEFFREY C HUTCHINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N PATRICK ST
DUBLIN TX
76446-1918
US

IV. Provider business mailing address

305 N PATRICK ST
DUBLIN TX
76446-1918
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-4900
  • Fax: 254-445-4693
Mailing address:
  • Phone: 254-445-4900
  • Fax: 254-445-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberK4088
License Number StateTX

VIII. Authorized Official

Name: MRS. MARY S MILLER
Title or Position: BILLING CLERK
Credential:
Phone: 254-445-4900