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General NPI Number Information
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NPI Number | 1265411581
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Entity Type | Individual
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Provider Name | CHARLES SCOT HITCHCOCK PA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 9040A JACKSON AVENUE, JOINT BASE LEWIS-MCCHORD 98341
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City | JOINT BASE LEWIS-MCCHORD
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State | WA
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Zip | 98341
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Country | US
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Telephone | 253-477-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 9040 A JACKSON AVENUE, JOINT BASE LEWIS-MCCHORD 98341
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City | TACOMA
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State | WA
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Zip | 98341
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Country | US
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Telephone | 253-477-0822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1070438
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2706
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License Number State | SC
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