Provider Demographics
NPI:1356359319
Name:HALLS PHYSICIAN SERVICE PLLC
Entity type:Organization
Organization Name:HALLS PHYSICIAN SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-922-1400
Mailing Address - Street 1:7000 MAYNARDVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918
Mailing Address - Country:US
Mailing Address - Phone:865-922-1400
Mailing Address - Fax:865-922-0928
Practice Address - Street 1:7000 MAYNARDVILLE HWY
Practice Address - Street 2:HALLS PHYSICIAN SERVICES PLLC
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37915
Practice Address - Country:US
Practice Address - Phone:865-922-1400
Practice Address - Fax:865-922-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730421Medicaid
TN4109370OtherBCBS
TN3730421Medicare ID - Type Unspecified