Basic Information
| Provider Information | |||||||||
| NPI: | 1114968252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | REGINALD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 PROSPECT AVE | ||||||||
| Address2: | SUITE 640 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165237000 | ||||||||
| FaxNumber: | 8165237095 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 PROSPECT AVE | ||||||||
| Address2: | SUITE 640 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165237000 | ||||||||
| FaxNumber: | 8165237095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-17241 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100092940I | 05 | KS | MEDICAID | 100092940K | 05 | KS | MEDICAID |