1356596860 NPI number — CHRIS E HALL OD PC

Table of content: (NPI 1356596860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356596860 NPI number — CHRIS E HALL OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRIS E HALL OD PC
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:
1356596860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G3548 FLUSHING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48504-4255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-2020
Provider Business Mailing Address Fax Number:
810-733-5980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G3548 FLUSHING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48504-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-733-2020
Provider Business Practice Location Address Fax Number:
810-733-5980
Provider Enumeration Date:
11/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DROOMER
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
810-733-2020

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  MI002793 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 94-1709401 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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