1083725204 NPI number — MS. MARY ALICE HALL MD

Table of content: MR. BENJAMIN DONALD REETZ PA-C (NPI 1023788536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083725204 NPI number — MS. MARY ALICE HALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
MARY
Provider Middle Name:
ALICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1083725204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC DOWELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41647-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-377-2492
Provider Business Mailing Address Fax Number:
606-377-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9788 KY RT 122
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
MC DOWELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41647-6042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-2492
Provider Business Practice Location Address Fax Number:
606-377-1018
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  13655 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020364400 . This is a "FEDERAL BLACK LUNG/DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64136559 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0303224 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 230264400 . This is a "DEPT OF LABOR/ACS UNIT/WO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000048789 . This is a "ANTHEM BLUE CROSS/SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011769726 . This is a "PALMETTO RAILROAD MEDICAR" identifier . This identifiers is of the category "OTHER".




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