Healthcare Provider Details

I. General information

NPI: 1952412173
Provider Name (Legal Business Name): MARY HALL MD FRANCISCO RIVERA MD AND ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9788 KY RT 122 STE 2
MC DOWELL KY
41647-6042
US

IV. Provider business mailing address

PO BOX 277
MC DOWELL KY
41647-0277
US

V. Phone/Fax

Practice location:
  • Phone: 606-377-2492
  • Fax: 606-377-1018
Mailing address:
  • Phone: 606-377-2492
  • Fax: 606-377-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ALICE HALL
Title or Position: PRESIDENT
Credential: MD
Phone: 606-377-2492