Provider Demographics
NPI:1932375813
Name:RICHARD A. HALL, D.O., PLC
Entity Type:Organization
Organization Name:RICHARD A. HALL, D.O., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-872-4725
Mailing Address - Street 1:4674 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1009
Mailing Address - Country:US
Mailing Address - Phone:989-872-4725
Mailing Address - Fax:
Practice Address - Street 1:4674 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1009
Practice Address - Country:US
Practice Address - Phone:989-872-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4111993Medicaid
MI5709132OtherBLUE CARE NETWORK
MI0857901324OtherBLUE CROSS BLUE SHIELD
MI4111993Medicaid
MI0M82780Medicare PIN