Provider Demographics
NPI:1952412173
Name:MARY HALL MD FRANCISCO RIVERA MD AND ASSOCIATES PSC
Entity Type:Organization
Organization Name:MARY HALL MD FRANCISCO RIVERA MD AND ASSOCIATES PSC
Other - Org Name:MARY A HALL MD & ASSOCIATES PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-377-2492
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0277
Mailing Address - Country:US
Mailing Address - Phone:606-377-2492
Mailing Address - Fax:606-377-1018
Practice Address - Street 1:9788 KY RT 122
Practice Address - Street 2:STE 2
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6042
Practice Address - Country:US
Practice Address - Phone:606-377-2492
Practice Address - Fax:606-377-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL3780OtherPALMETTO RAILROAD MEDICAR
KY65913402Medicaid
0303224OtherUMWA
020364400OtherFEDERAL BLACK LUNG/DOL
CL3780OtherPALMETTO RAILROAD MEDICAR
KY0414Medicare ID - Type Unspecified