Provider Demographics
NPI:1821150855
Name:HATFIELD PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:HATFIELD PHYSICIAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-487-3625
Mailing Address - Street 1:PO BOX 1857
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-1419
Mailing Address - Country:US
Mailing Address - Phone:205-487-3625
Mailing Address - Fax:205-487-7559
Practice Address - Street 1:200 CARAWAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5048
Practice Address - Country:US
Practice Address - Phone:205-487-3625
Practice Address - Fax:205-487-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550529Medicaid
AL05150448OtherBLUE CROSS BLUE SHIELD
ALH13228Medicare UPIN
AL051550529Medicare ID - Type Unspecified