Basic Information
| Provider Information | |||||||||
| NPI: | 1407871908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATCH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | CLARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 362 | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691030362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
| FaxNumber: | 3086476433 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W LEOTA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691016525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
| FaxNumber: | 3086476433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 21277 | NE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7705720 | 05 | SD | MEDICAID | 300133488 | 01 | MEDICARE RAILROAD | OTHER | 35792 | 01 | NE | BLUE CROSS / BLUE SHIELDS | OTHER |