Provider Demographics
NPI:1295920031
Name:EDWARD R. HUTCHISON, M.D., INC DBA PLACENTIA LINDA FAMILY MEDICAL CENT
Entity type:Organization
Organization Name:EDWARD R. HUTCHISON, M.D., INC DBA PLACENTIA LINDA FAMILY MEDICAL CENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-996-2390
Mailing Address - Street 1:2874 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6714
Mailing Address - Country:US
Mailing Address - Phone:714-996-2390
Mailing Address - Fax:714-996-3804
Practice Address - Street 1:2874 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6714
Practice Address - Country:US
Practice Address - Phone:714-996-2390
Practice Address - Fax:714-996-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 38827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47613Medicare UPIN