1548379415 NPI number — JEFFREY M HALL M.D.

Table of content: JEFFREY M HALL M.D. (NPI 1548379415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548379415 NPI number — JEFFREY M HALL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1548379415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CROIX FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54024-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-483-3221
Provider Business Mailing Address Fax Number:
715-483-0539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CROIX FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54024-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-483-3221
Provider Business Practice Location Address Fax Number:
715-483-0539
Provider Enumeration Date:
08/30/2006

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:  43332 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP33867 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NA9031021478 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34108200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080176516 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0107426 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063J5HA . This is a "BC BS MN FACILITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150D3HA . This is a "BC BS MN PRO FEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 417760600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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