MEDICARE: MONICA L HATCH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	5680506-1206	UT
2	363A00000X	Physician Assistant	5680506-1206	UT

General Provider Information

NPI Number	:	1336493709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA L HATCH PA-C

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:	801-825-3904

Provider Business Practice Location Address
First Line	:	3903 MEDICAL DR STE 100
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2316
Country	:	US
Telephone Number	:	801-387-8900
Fax Number	:	801-387-8920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	06/20/2024

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Directions to “ MONICA L HATCH PA-C” Practice Location

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