Provider Demographics
NPI:1710022249
Name:TERRY E. HALL
Entity Type:Organization
Organization Name:TERRY E. HALL
Other - Org Name:TERRY E HALL MD RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-425-7443
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:2703 MILLER STREET
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0233
Mailing Address - Country:US
Mailing Address - Phone:660-425-7443
Mailing Address - Fax:660-425-6516
Practice Address - Street 1:2703 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2704
Practice Address - Country:US
Practice Address - Phone:660-425-7443
Practice Address - Fax:660-425-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
263841Medicare Oscar/Certification