1104743327 NPI number — SIDNEY HAIL DC

Table of content: SIDNEY HAIL DC (NPI 1104743327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104743327 NPI number — SIDNEY HAIL DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIL
Provider First Name:
SIDNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1104743327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2257
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40423-2257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-374-1479
Provider Business Mailing Address Fax Number:
551-267-7227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MASTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-374-1479
Provider Business Practice Location Address Fax Number:
551-267-7227
Provider Enumeration Date:
06/30/2026

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: 111N00000X , with the licence number:  309254 , 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: 7100695930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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