Provider Demographics
NPI:1073974135
Name:HATCH PEDIATRICS LLC
Entity Type:Organization
Organization Name:HATCH PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-580-1046
Mailing Address - Street 1:280 W KAGY BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6056
Mailing Address - Country:US
Mailing Address - Phone:406-580-1046
Mailing Address - Fax:
Practice Address - Street 1:280 W KAGY BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6056
Practice Address - Country:US
Practice Address - Phone:406-580-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty