Provider Demographics
NPI:1659402006
Name:HATCHIE CLINIC P C
Entity Type:Organization
Organization Name:HATCHIE CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MESSENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-659-2273
Mailing Address - Street 1:640 NUCKOLLS RD
Mailing Address - Street 2:PO BOX 331
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1532
Mailing Address - Country:US
Mailing Address - Phone:731-659-2273
Mailing Address - Fax:731-659-2777
Practice Address - Street 1:640 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1532
Practice Address - Country:US
Practice Address - Phone:731-659-2273
Practice Address - Fax:731-659-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG63245Medicare UPIN