Basic Information
| Provider Information | |||||||||
| NPI: | 1134129539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM E. HALL MD, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1911 K M WICKER MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273305070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197751000 | ||||||||
| FaxNumber: | 9197753377 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 K M WICKER MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273305070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197751000 | ||||||||
| FaxNumber: | 9197753377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9197751000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 80929 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 010063303 | 01 | RAILROAD MEDICARE | OTHER | 203534F | 01 | NC | RENDERING PROVIDER | OTHER | 8938431 | 05 | NC | MEDICAID |