Provider Demographics
NPI:1730358334
Name:THOMAS KENT HALL MDPC
Entity type:Organization
Organization Name:THOMAS KENT HALL MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-569-8575
Mailing Address - Street 1:PO BOX 4527
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4527
Mailing Address - Country:US
Mailing Address - Phone:423-569-8575
Mailing Address - Fax:423-569-5880
Practice Address - Street 1:19295 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6064
Practice Address - Country:US
Practice Address - Phone:423-569-8575
Practice Address - Fax:423-569-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000090402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2001147OtherBLUE CROSS
KY64772874Medicaid
TN164066OtherBLACK LUNG
TN3386048Medicaid
KY64772874Medicaid
TN2001147OtherBLUE CROSS
TN3386048Medicare PIN