1699904458 NPI number — JARED A HALL DPM PC

Table of content: (NPI 1699904458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699904458 NPI number — JARED A HALL DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JARED A HALL DPM 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:
1699904458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5171 S CUB LAKE RD STE B230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOW LOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85901-7882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-537-4111
Provider Business Mailing Address Fax Number:
928-532-1123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5171 S CUB LAKE RD STE B230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOW LOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85901-7882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-537-4111
Provider Business Practice Location Address Fax Number:
928-537-4111
Provider Enumeration Date:
07/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
JARED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-537-4111

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0667 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 271532 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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