MEDICARE: MR. FREDERICK THOMAS 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	363A00000X	Physician Assistant	2145	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	356676ZGZ2	OTHER	CO	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1861434003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDERICK THOMAS HATCH PA-C

Provider Business Mailing Address
First Line	:	6160 TUTT BLVD
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3500
Country	:	US
Telephone Number	:	719-473-2346
Fax Number	:	719-577-9627

Provider Business Practice Location Address
First Line	:	6160 TUTT BLVD
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3500
Country	:	US
Telephone Number	:	719-473-2346
Fax Number	:	719-577-9627

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/26/2016

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Directions to “ MR. FREDERICK THOMAS HATCH PA-C” Practice Location

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