MEDICARE: MRS. JAIME HATCLIFF P.A.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	363A00000X	Physician Assistant	867	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970018972	OTHER	NE	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1205839982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME HATCLIFF P.A.C.

Provider Business Mailing Address
First Line	:	1101 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-3436
Fax Number	:	402-223-4515

Provider Business Practice Location Address
First Line	:	1101 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-3436
Fax Number	:	402-223-4515

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/15/2011

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