1225127756 NPI number — HUTCHINSON SUPERSTORE INC

Table of content: (NPI 1225127756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225127756 NPI number — HUTCHINSON SUPERSTORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUTCHINSON SUPERSTORE INC
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:
Provider Other Organization Name Type Code:
6
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:
1225127756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1059 HIGHWAY 15 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55350-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1059 HIGHWAY 15 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55350-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-587-4744
Provider Business Practice Location Address Fax Number:
320-587-9168
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOPPE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
320-587-4744

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 115398 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47807DU . This is a "BCBS EXAMS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 737262100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030701096 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47807DU . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP29396 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2128810 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8343959 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47808DU . This is a "BCBS EYEWEAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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