Provider Demographics
NPI:1740709906
Name:HALL PODIATRY LLC
Entity type:Organization
Organization Name:HALL PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-826-0534
Mailing Address - Street 1:PO BOX 8524
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-8524
Mailing Address - Country:US
Mailing Address - Phone:405-826-0534
Mailing Address - Fax:405-285-8921
Practice Address - Street 1:20 SW 132ND TERRACE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-826-0534
Practice Address - Fax:405-285-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK126261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100116430AMedicaid