Healthcare Provider Details

I. General information

NPI: 1700986270
Provider Name (Legal Business Name): AUGUSTA ELLICE HAYS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUGUSTA ELLICE HALLETT MD

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W. BROADWAY AVE.
AVA MO
65608-1359
US

IV. Provider business mailing address

PO BOX 1359
AVA MO
65608-1359
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-5739
  • Fax:
Mailing address:
  • Phone: 417-683-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5134
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101244586
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP4960
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018030005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: