Provider Demographics
NPI:1750359626
Name:TERRY E. HALL, M.D
Entity type:Organization
Organization Name:TERRY E. HALL, M.D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-7443
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0233
Mailing Address - Country:US
Mailing Address - Phone:660-425-7443
Mailing Address - Fax:660-425-6516
Practice Address - Street 1:2703 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2704
Practice Address - Country:US
Practice Address - Phone:660-425-7443
Practice Address - Fax:660-425-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
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
L490000Medicare ID - Type Unspecified