1003818774 NPI number — GRACE HALL PT

Table of content: GRACE HALL PT (NPI 1003818774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003818774 NPI number — GRACE HALL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
GRACE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003818774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 GREENWELLS GLORY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILTMORE LAKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28715-8901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-665-4849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 BLEACHERY BLVD
Provider Second Line Business Practice Location Address:
SUITE # 201
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-8314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-277-5763
Provider Business Practice Location Address Fax Number:
828-277-5764
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  4693 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10602 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7232360 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com