MEDICARE: DR. AUGUSTA ELLICE HAYS MD

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	207Q00000X	Family Medicine Physician	5134	AK
2	207Q00000X	Family Medicine Physician	0101244586	VA
3	207Q00000X	Family Medicine Physician	P4960	TX
4	207Q00000X	Family Medicine Physician	2018030005	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2018030005	OTHER	MO	MISSOURI LICENSE BUREAU
2	2500050484	OTHER	MO	MISSOURI BNDD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	AZ0765920	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1700986270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUSTA ELLICE HAYS MD

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-5739
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 W. BROADWAY AVE.
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-5739
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	05/01/2020

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