MEDICARE: MRS. MARIE ELAINE HALL PA-C

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	363AM0700X	Medical Physician Assistant	PA02743	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194878314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE ELAINE HALL PA-C

Provider Business Mailing Address
First Line	:	204 E 1ST ST
Second Line	:
City	:	ALICE
State	:	TX
Zip	:	78332-4822
Country	:	US
Telephone Number	:	361-664-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 E. SAN PATRICIO
Second Line	:
City	:	MATHIS
State	:	TX
Zip	:	78368-2266
Country	:	US
Telephone Number	:	361-547-4121
Fax Number	:	361-547-4132

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/24/2018

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