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General NPI Number Information
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NPI Number | 1407266265
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Entity Type | Organization
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Legal Business Name | BROOKFIELD MEDICAL CLINIC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 308 N MAIN ST
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City | BROOKFIELD
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State | MO
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Zip | 64628-1601
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Country | US
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Telephone | 660-258-7544
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Fax | 660-258-7577
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | BROOKFIELD
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State | MO
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Zip | 64628-0464
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Country | US
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Telephone | 660-258-7544
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Fax | 660-258-7577
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Authorized Official
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Title or Position | OWNER
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Name | NANCY A HUTCHINSON
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Credential | D.O.
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Telephone | 660-258-7544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30110
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License Number State | MO
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