1376709097 NPI number — HAWKEYE CLINIC OF HUTCHINSON II, P.C.

Table of content: (NPI 1376709097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376709097 NPI number — HAWKEYE CLINIC OF HUTCHINSON II, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWKEYE CLINIC OF HUTCHINSON II, P.C.
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:
1376709097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 187
Provider Second Line Business Mailing Address:
225 MAIN ST S.
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55350-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-587-2593
Provider Business Mailing Address Fax Number:
320-587-5852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MAIN ST 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:
55350-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-587-2593
Provider Business Practice Location Address Fax Number:
320-587-5852
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GLASER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
320-587-2593

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2775 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22-01141 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 692690800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90332 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 342J8CR . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 774461025292 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040506009 . This is a "PRIMEWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2775 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 342J7CR . This is a "BLUE PLUS MATERIALS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410046161 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H379 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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