1093825705 NPI number — RONALD D HALL MD

Table of content: (NPI 1093825705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093825705 NPI number — RONALD D HALL MD

Organization/Personal Information

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

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:
1093825705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41502-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-432-5532
Provider Business Mailing Address Fax Number:
606-432-5564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1098 S MAYO TRL
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-5532
Provider Business Practice Location Address Fax Number:
606-432-5564
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-432-5532

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  19685 , 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: 46151 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4332165 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65901837 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048726 . This is a "ANTHEM OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 64196850 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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