Basic Information
Provider Information | |||||||||
NPI: | 1215191903 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MYRIAM D HUTCHINSON MD | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1228 | ||||||||
Address2: |   | ||||||||
City: | YOUNGSVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 705921228 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3378932438 | ||||||||
FaxNumber: | 3378938170 | ||||||||
Practice Location | |||||||||
Address1: | 104 N. HOSPITAL DR. | ||||||||
Address2: |   | ||||||||
City: | ABBEVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 705104039 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3378932438 | ||||||||
FaxNumber: | 3378938170 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2008 | ||||||||
LastUpdateDate: | 07/11/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HUTCHINSON | ||||||||
AuthorizedOfficialFirstName: | MYRIAM | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
AuthorizedOfficialTelephone: | 3378932438 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 025389 | LA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
ID | Type | State | Issuer | Description | 1486906 | 05 | LA |   | MEDICAID |