Basic Information
Provider Information
NPI: 1154611689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUTCHINS
FirstName: JEREMY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2811 TIETON DR
Address2:  
City: YAKIMA
State: WA
PostalCode: 989023761
CountryCode: US
TelephoneNumber: 5095758000
FaxNumber:  
Practice Location
Address1: 2811 TIETON DR
Address2:  
City: YAKIMA
State: WA
PostalCode: 989023761
CountryCode: US
TelephoneNumber: 5095758000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/18/2011
LastUpdateDate: 03/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XOP60550941WAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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