Basic Information
| Provider Information | |||||||||
| NPI: | 1679505416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUTCHINSON AREA HC ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 10TH ST | ||||||||
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| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553874552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1095 HIGHWAY 15 S | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553505000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202344603 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | GRAVES | ||||||||
| AuthorizedOfficialFirstName: | PHIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9524429770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 60163HU | 01 | MN | BLUE CROSS OF MN | OTHER | 128183 | 01 | MN | CHOICEPLUS | OTHER | C02993 | 01 | MN | MEDICARE GROUP | OTHER |