MEDICARE: JORDAN HATCH MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	01092640A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538746284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HATCH MD

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:	PROVIDER SERVICES-ENROLLMENT
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 W CLEVELAND ROAD EXT
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-6090
Country	:	US
Telephone Number	:	574-335-8450
Fax Number	:	574-335-0780

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	07/23/2024

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