Provider Demographics
NPI:1003075219
Name:ZACK HALL, MD PLLC
Entity Type:Organization
Organization Name:ZACK HALL, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-342-6060
Mailing Address - Street 1:217 TURNER DR STE F
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5754
Mailing Address - Country:US
Mailing Address - Phone:336-342-6060
Mailing Address - Fax:336-342-6068
Practice Address - Street 1:217 TURNER DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5754
Practice Address - Country:US
Practice Address - Phone:336-342-6060
Practice Address - Fax:336-342-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907415Medicaid