Basic Information
| Provider Information | |||||||||
| NPI: | 1528255395 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUTCHINSON HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HUTCHINSON HEALTH DASSEL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 HIGHWAY 15 S | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553505000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202345000 | ||||||||
| FaxNumber: | 3204844688 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | DASSEL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202753358 | ||||||||
| FaxNumber: | 3202345051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LARSON | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3204844472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.