Provider Demographics
NPI:1093825705
Name:RONALD D HALL MD
Entity Type:Organization
Organization Name:RONALD D HALL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-5532
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2500
Mailing Address - Country:US
Mailing Address - Phone:606-432-5532
Mailing Address - Fax:606-432-5564
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:SUITE 211
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-432-5532
Practice Address - Fax:606-432-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY46151OtherANTHEM BC/BS
KY4332165OtherAETNA
KY65901837Medicaid
VA048726OtherANTHEM OF VA
KY64196850Medicaid
KY5522Medicare PIN
KY5522Medicare ID - Type Unspecified
KY65901837Medicaid