Provider Demographics
NPI:1790227684
Name:HAL MEDICAL O&P
Entity Type:Organization
Organization Name:HAL MEDICAL O&P
Other - Org Name:HAL MEDICAL O&P
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRYHILL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:256-230-2321
Mailing Address - Street 1:108 CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-4417
Mailing Address - Country:US
Mailing Address - Phone:256-230-2321
Mailing Address - Fax:256-230-2323
Practice Address - Street 1:713B PRESIDENT PL
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5652
Practice Address - Country:US
Practice Address - Phone:256-230-2321
Practice Address - Fax:256-230-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL170309332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL184706Medicaid
AL184706Medicaid