Provider Demographics
NPI:1396943221
Name:MARTIN R HALL MD. SC.
Entity type:Organization
Organization Name:MARTIN R HALL MD. SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-799-1144
Mailing Address - Street 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:708-799-1144
Mailing Address - Fax:708-799-4899
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-799-1144
Practice Address - Fax:708-799-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036580A207X00000X
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDE2045OtherRAILROAD MEDICARE
IL31603346OtherBCBS
ILDD9203OtherRAILROAD MEDICARE
IL31603346OtherBCBS
INDE2045OtherRAILROAD MEDICARE
IL1023490001Medicare NSC
D95146Medicare UPIN
IN409670Medicare PIN