Provider Demographics
NPI:1508046624
Name:KEARN D HINCHMAN D O INC
Entity Type:Organization
Organization Name:KEARN D HINCHMAN D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-258-6316
Mailing Address - Street 1:53779 GENERATIONS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1576
Mailing Address - Country:US
Mailing Address - Phone:574-258-6316
Mailing Address - Fax:574-258-6307
Practice Address - Street 1:53779 GENERATIONS DR STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1576
Practice Address - Country:US
Practice Address - Phone:574-258-6316
Practice Address - Fax:574-258-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001423A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF63231Medicare UPIN