Provider Demographics
NPI:1275361545
Name:HITCHCOCK FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:HITCHCOCK FAMILY MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-456-9134
Mailing Address - Street 1:5104 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3932
Mailing Address - Country:US
Mailing Address - Phone:423-456-9134
Mailing Address - Fax:423-769-0020
Practice Address - Street 1:5104 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3932
Practice Address - Country:US
Practice Address - Phone:423-456-9134
Practice Address - Fax:423-769-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty