Provider Demographics
NPI:1184679714
Name:HALL, WILLIAM J (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4920
Mailing Address - Country:US
Mailing Address - Phone:419-690-7653
Mailing Address - Fax:419-697-7726
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7653
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201559367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4835661Medicaid
MI4596689Medicaid
OHH067420OtherMEDICARE
OH3122507Medicaid
MIP00129258Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MI0P27050018Medicare ID - Type Unspecified
OH3122507Medicaid