MEDICARE: HALLS PHYSICIAN SERVICE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4109370	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1356359319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLS PHYSICIAN SERVICE PLLC

Provider Business Mailing Address
First Line	:	7000 MAYNARDVILLE HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918
Country	:	US
Telephone Number	:	865-922-1400
Fax Number	:	865-922-0928

Provider Business Practice Location Address
First Line	:	7000 MAYNARDVILLE HWY
Second Line	:	HALLS PHYSICIAN SERVICES PLLC
City	:	KNOXVILLE
State	:	TN
Zip	:	37915
Country	:	US
Telephone Number	:	865-922-1400
Fax Number	:	865-922-0928

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	HANA H MIRANI
Credential	:
Telephone Number	:	865-922-1400

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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Directions to “HALLS PHYSICIAN SERVICE PLLC ” Practice Location

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