Provider Demographics
NPI:1174089361
Name:MICHAEL O. MCCUTCHEON
Entity type:Organization
Organization Name:MICHAEL O. MCCUTCHEON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-773-6579
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-1148
Mailing Address - Country:US
Mailing Address - Phone:256-773-6579
Mailing Address - Fax:256-773-6570
Practice Address - Street 1:819 HIGHWAY 31 NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4412
Practice Address - Country:US
Practice Address - Phone:256-773-6579
Practice Address - Fax:256-773-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental