=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003790833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VELDA RON HALL CPRS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 14059
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45250-0059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-237-7575
-----------------------------------------------------
Fax | 859-331-1385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14059
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45250-0059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-237-7575
-----------------------------------------------------
Fax | 859-331-1385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | APS.006349
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------