Healthcare Provider Details

I. General information

NPI: 1598830572
Provider Name (Legal Business Name): JODI M. HALE CPO, LPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S JACKSON ST
SAN ANGELO TX
76904-5129
US

IV. Provider business mailing address

4601 HARTFORD ST
ABILENE TX
79605-4603
US

V. Phone/Fax

Practice location:
  • Phone: 325-223-6300
  • Fax: 325-223-6406
Mailing address:
  • Phone: 325-793-3400
  • Fax: 325-793-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: