MEDICARE: TERRY E. HALL

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1710022249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY E. HALL

Provider Business Mailing Address
First Line	:	PO BOX 233
Second Line	:	2703 MILLER STREET
City	:	BETHANY
State	:	MO
Zip	:	64424-0233
Country	:	US
Telephone Number	:	660-425-7443
Fax Number	:	660-425-6516

Provider Business Practice Location Address
First Line	:	2703 MILLER ST
Second Line	:
City	:	BETHANY
State	:	MO
Zip	:	64424-2704
Country	:	US
Telephone Number	:	660-425-7443
Fax Number	:	660-425-6516

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRY E HALL
Credential	:	M.D
Telephone Number	:	660-425-7443

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/13/2007

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