MEDICARE: MR. RON HALE M.S.W.

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	1041C0700X	Clinical Social Worker	SW2053	FL

General Provider Information

NPI Number	:	1669498994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RON HALE M.S.W.

Provider Business Mailing Address
First Line	:	6164 COUNTY ROAD 248A
Second Line	:
City	:	LAKE PANASOFFKEE
State	:	FL
Zip	:	33538-3024
Country	:	US
Telephone Number	:	352-748-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 W MARC KNIGHTON CT
Second Line	:
City	:	LECANTO
State	:	FL
Zip	:	34461-6300
Country	:	US
Telephone Number	:	352-746-8004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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