=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043298474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUTCHINSON CLINIC, P.A., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2006
-----------------------------------------------------
Last Update Date | 09/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 N WALDRON ST
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-669-2500
-----------------------------------------------------
Fax | 620-669-2598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 N WALDRON ST
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-669-2500
-----------------------------------------------------
Fax | 620-669-2598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MICHAEL HECK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-669-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------