Provider Demographics
NPI:1770585200
Name:HATCH, DENNIS (MD)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:HATCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4451
Mailing Address - Country:US
Mailing Address - Phone:402-463-4521
Mailing Address - Fax:
Practice Address - Street 1:715 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4451
Practice Address - Country:US
Practice Address - Phone:402-463-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15969174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE32331OtherBLUE CROSS BLUE SHIELD NE
NE1770585200Medicaid
NE275490Medicare ID - Type Unspecified
NEE56851Medicare UPIN
NE1770585200Medicaid