MEDICARE: HULETT FAMILY PRACTICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1033217906	OTHER	MO	NPI, TYPE 1

General Provider Information

NPI Number	:	1427284504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HULETT FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	103 11TH ST
Second Line	:	SUITE 6
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-646-1435
Fax Number	:	660-646-4643

Provider Business Practice Location Address
First Line	:	103 11TH ST
Second Line	:	SUITE 6
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-646-1435
Fax Number	:	660-646-4643

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHRISTOPHER E HULETT
Credential	:	D.O.
Telephone Number	:	660-646-1435

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	07/29/2009

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Directions to “HULETT FAMILY PRACTICE, LLC ” Practice Location

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