Provider Demographics
NPI:1205136884
Name:HALL ANESTHESIA INC
Entity type:Organization
Organization Name:HALL ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:909-289-2550
Mailing Address - Street 1:12652 MAR VISTA DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-2703
Mailing Address - Country:US
Mailing Address - Phone:909-289-2550
Mailing Address - Fax:760-247-9593
Practice Address - Street 1:12652 MAR VISTA DR
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-2703
Practice Address - Country:US
Practice Address - Phone:909-289-2550
Practice Address - Fax:760-247-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3180367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty