Provider Demographics
NPI:1124052659
Name:HITCHCOCK, JAMES RICHARD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-4949
Practice Address - Fax:507-238-3377
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP88102OtherHEALTHPARTNERS
MN615P0HIOtherBLUE CROSS BLUE SHIELD
20026OtherAVERA
65451OtherSANFORD HEALTH
974311053869OtherPREFERREDONE
MN615P0HIOtherBLUE CROSS BLUE SHIELD