Provider Demographics
NPI:1336588896
Name:HATCHER, JOHN (SJ)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HATCHER
Suffix:
Gender:M
Credentials:SJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:SD
Mailing Address - Zip Code:57572-0499
Mailing Address - Country:US
Mailing Address - Phone:605-747-2361
Mailing Address - Fax:605-747-5057
Practice Address - Street 1:350 OAK ST.
Practice Address - Street 2:
Practice Address - City:ST. FRANCIS
Practice Address - State:SD
Practice Address - Zip Code:57572
Practice Address - Country:US
Practice Address - Phone:605-747-2361
Practice Address - Fax:605-747-5057
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD46-6000-411171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator