Provider Demographics
NPI:1861710303
Name:JOHN E HATEGAN, M.D. P C
Entity type:Organization
Organization Name:JOHN E HATEGAN, M.D. P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HATEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-883-9121
Mailing Address - Street 1:101 CONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2305
Mailing Address - Country:US
Mailing Address - Phone:812-883-9121
Mailing Address - Fax:812-883-2161
Practice Address - Street 1:101 CONNIE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2305
Practice Address - Country:US
Practice Address - Phone:812-883-9121
Practice Address - Fax:812-883-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200285990AMedicaid
IN209330Medicare PIN
IN200285990AMedicaid