1407990260 NPI number — MARY V. HUTCHISON

Table of content: (NPI 1407990260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407990260 NPI number — MARY V. HUTCHISON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY V. HUTCHISON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNTRY VALLEY HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407990260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15750 COUNTY ROAD 2430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JAMES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65559-8211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-265-8250
Provider Business Mailing Address Fax Number:
573-265-8250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15750 COUNTY ROAD 2430
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JAMES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65559-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-265-8250
Provider Business Practice Location Address Fax Number:
573-265-8250
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUTCHISON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
V
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
573-265-8250

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  032248 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 266794007 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com