Provider Demographics
NPI:1952065328
Name:HALLMEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:HALLMEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL-GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:931-722-2800
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0689
Mailing Address - Country:US
Mailing Address - Phone:931-722-2800
Mailing Address - Fax:931-722-9627
Practice Address - Street 1:107 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2440
Practice Address - Country:US
Practice Address - Phone:931-722-2800
Practice Address - Fax:931-722-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty