Provider Demographics
NPI:1356838023
Name:SANDRA K HUTCHISON MD PLLC
Entity Type:Organization
Organization Name:SANDRA K HUTCHISON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-328-5612
Mailing Address - Street 1:403 OGLETREE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9444
Mailing Address - Country:US
Mailing Address - Phone:936-328-5612
Mailing Address - Fax:936-328-5619
Practice Address - Street 1:403 OGLETREE DR STE 105
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-328-5612
Practice Address - Fax:936-328-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX062567507Medicaid