Provider Demographics
NPI:1053494971
Name:HALL, BILLIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:511 STRATTON ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3806
Mailing Address - Country:US
Mailing Address - Phone:304-752-0686
Mailing Address - Fax:
Practice Address - Street 1:LOGAN REGIONAL MEDICAL CENTER EMER DEPT
Practice Address - Street 2:20 HOSPITAL DRIVE
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-831-1188
Practice Address - Fax:304-831-1189
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006671Medicaid
KY64128416Medicaid
WVP00342826OtherRAILROAD MEDICARE
WVHA4195571Medicare PIN