1174651608 NPI number — THOMAS KENT HALL M.D.

Table of content: JUAN E VARGAS MD (NPI 1538783840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174651608 NPI number — THOMAS KENT HALL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
THOMAS
Provider Middle Name:
KENT
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:
1174651608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18701 SE CROSSWINDS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33478-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-617-7551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 NW 13TH ST STE 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33486-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-447-9341
Provider Business Practice Location Address Fax Number:
561-447-9352
Provider Enumeration Date:
02/28/2007

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: 2085R0202X , with the licence number:  MD0000009040 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 621244650 . This is a "CHAMPUS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3386048 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2001147 . This is a "BLUE CROSS TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 164066 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62124465001 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64772874 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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