Healthcare Provider Details

I. General information

NPI: 1861434003
Provider Name (Legal Business Name): FREDERICK THOMAS HATCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRED HATCH PA-C

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD SUITE 100
COLORADO SPRINGS CO
80923-3500
US

IV. Provider business mailing address

6160 TUTT BLVD SUITE 100
COLORADO SPRINGS CO
80923-3500
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-2346
  • Fax: 719-577-9627
Mailing address:
  • Phone: 719-473-2346
  • Fax: 719-577-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2145
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: