Provider Demographics
NPI:1861434003
Name:HATCH, FREDERICK THOMAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:THOMAS
Last Name:HATCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6160 TUTT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3500
Mailing Address - Country:US
Mailing Address - Phone:719-473-2346
Mailing Address - Fax:719-577-9627
Practice Address - Street 1:6160 TUTT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3500
Practice Address - Country:US
Practice Address - Phone:719-473-2346
Practice Address - Fax:719-577-9627
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO356676ZGZ2OtherMEDICARE PTAN
CO56975848Medicaid
CO356676ZGZ2OtherMEDICARE PTAN