Provider Demographics
NPI:1295406775
Name:HALLSVILLE MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:HALLSVILLE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:YATES-HALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:903-668-7462
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0873
Mailing Address - Country:US
Mailing Address - Phone:903-668-7462
Mailing Address - Fax:903-668-7400
Practice Address - Street 1:209 W MAIN ST SUITE D
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650
Practice Address - Country:US
Practice Address - Phone:903-668-7462
Practice Address - Fax:903-668-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty