Provider Demographics
NPI:1710168547
Name:ANDREW D. HEWCHUCK, D.P.M., INC.
Entity Type:Organization
Organization Name:ANDREW D. HEWCHUCK, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-872-1636
Mailing Address - Street 1:310 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3413
Mailing Address - Country:US
Mailing Address - Phone:760-872-1636
Mailing Address - Fax:
Practice Address - Street 1:310 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3413
Practice Address - Country:US
Practice Address - Phone:760-872-1636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3878213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38780Medicaid
CA000E38780Medicare PIN
CAU42983Medicare UPIN