Provider Demographics
NPI:1164016036
Name:417 HOUSECALLS
Entity Type:Organization
Organization Name:417 HOUSECALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:417-363-3900
Mailing Address - Street 1:1335 E REPUBLIC RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7220
Mailing Address - Country:US
Mailing Address - Phone:417-363-3900
Mailing Address - Fax:417-313-9998
Practice Address - Street 1:1335 E REPUBLIC RD STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7220
Practice Address - Country:US
Practice Address - Phone:417-363-3900
Practice Address - Fax:417-313-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty