Provider Demographics
NPI:1700986270
Name:HAYS, AUGUSTA ELLICE (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTA
Middle Name:ELLICE
Last Name:HAYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUGUSTA
Other - Middle Name:ELLICE
Other - Last Name:HALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1359
Mailing Address - Country:US
Mailing Address - Phone:417-683-5739
Mailing Address - Fax:
Practice Address - Street 1:504 W. BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-1359
Practice Address - Country:US
Practice Address - Phone:417-683-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5134207Q00000X
VA0101244586207Q00000X
TXP4960207Q00000X
MO2018030005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018030005OtherMISSOURI LICENSE BUREAU
MO2500050484OtherMISSOURI BNDD
AZ878803Medicaid
AZAZ0765920OtherBCBS
AZ030078Medicare Oscar/Certification
AZ8HC673Medicare ID - Type UnspecifiedPART B