Provider Demographics
NPI:1972683787
Name:WILLIAM R HALE MD INC
Entity Type:Organization
Organization Name:WILLIAM R HALE MD INC
Other - Org Name:ORTHOPEDIC MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALE MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-623-8547
Mailing Address - Street 1:1800 N ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3006
Mailing Address - Country:US
Mailing Address - Phone:909-623-8547
Mailing Address - Fax:909-623-3644
Practice Address - Street 1:1800 N ORANGE GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3006
Practice Address - Country:US
Practice Address - Phone:909-623-8547
Practice Address - Fax:909-623-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C266460Medicaid
CAA33173Medicare UPIN
CA00C266460Medicaid