JACK E HALL (NPI# 1619284239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619284239 |
| Entity Type | Individual |
| Full Name | JACK E HALL |
| Credential | PA |
| Practice Address |
121 S Crescent Dr Pueblo West CO 81007-5434 |
| Mailing Address |
Po Box 560825 Denver CO 80256-0825 |
| Practice Telephone | 7195957575 |
| Practice Fax Number | 7195478368 |
| Mailing Telephone | 7195957580 |
| Mailing Fax Number | 7195450176 |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2016-02-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
535 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 63254808 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285269662 | Jack Reynolds Hall IIi | Specialist/Technologist | 6339 Middle Ground Rd, Statesboro, GA 30461-8434 | 2020-03-06 |
| 1669930145 | Jack Tyson Hall | Nurse Practitioner | 400 Taylor Rd, Montgomery, AL 36117-3512 | 2019-03-04 |
| 1740605906 | Jack Brian Hall I | Pharmacist | 3360 Front St, Winnsboro, LA 71295-6487 | 2014-02-25 |
| 1639228331 | Jack Grey Hall | Optometrist | 3801 Pelandale Ave, Modesto, CA 95356-8300 | 2007-01-10 |
| 1558337857 | Jack J Hall | Internal Medicine | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2006-02-27 |
| 1881676427 | Jack E Hall Jr. | Physician Assistant | 100 Mercy Way, Ste 430, Joplin, MO 64804-4524 | 2005-11-18 |
| Street Address |
121 S CRESCENT DR |
| City | PUEBLO WEST |
| State | CO |
| Zip Code | 81007-5434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407063563 | Dana R Bennett Md PC | Family Medicine | 121 S Crescent Dr, Pueblo West, CO 81007-5433 | 2007-05-17 |
| 1275753519 | Dana Ransom Bennett | Family Medicine | 121 S Crescent Dr, Pueblo West, CO 81007-5433 | 2007-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811406630 | Southern Colorado Hearing Associates, Inc. | Audiologist | 904 East Hailey Lane, Pueblo West, CO 81007 | 2017-09-25 |
| 1396274361 | Laura Selig | Physical Therapist | 1168 N Thorpe Dr, Pueblo West, CO 81007 | 2017-06-05 |
| 1710351127 | Benjamin Gaines | Speech-Language Pathologist | 1056 W Broken Bow Dr, Pueblo West, CO 81007 | 2015-11-23 |
| 1467861351 | Zoe Grillos | Massage Therapist | 876 S Knox Dr, Pueblo West, CO 81007 | 2014-08-05 |
| 1033454186 | Melissa Lynn Hollis | Occupational Therapy Assistant | 1333 N Blue Lake Ln, Pueblo West, CO 81007 | 2012-11-30 |
| 1336491125 | Patricia Deana Cuadrado | General Practice | 44 E. Spaulding Ave., Pueblo West, CO 81007 | 2012-10-04 |
| 1194088021 | Aaron J Wilson | Chiropractor | 50 S Dunlap Dr, Pueblo West, CO 81007 | 2012-06-15 |
| 1780811893 | Rhonda Renee Grigg | Pediatrics | 332 S Orchard Springs Dr. 150, Pueblo, CO 81007 | 2009-06-16 |
| 1144482191 | Christopher Nicholas Liontas | Dentist | 360 S. Orchard Springs Dr, Pueblo West, CO 81007 | 2008-07-01 |
| 1780855718 | Justin Dean Youngren | Chiropractor | 50 S Dunlap Drive, Pueblo West, CO 81007 | 2008-03-18 |
| Find all providers in zip 81007 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174867279 | Brooke Nicole Deweese | Physician Assistant | 121 S. Crescent Drive, Pueblo West, CO 81007-5433 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677240 | Monique Minter | Physician Assistant | 5504 Malta St, Denver, CO 80249-8649 | 2020-10-23 |
| 1700430261 | Brianne Tanae Harper | Physician Assistant | 2530 N 8th St Suite 205, Grand Junction, CO 81501 | 2019-08-01 |
| 1013478445 | Robin Elise Feldman | Physician Assistant | 17033 E Dorado Dr, Centennial, CO 80015-3029 | 2019-03-28 |
| 1780141895 | Wendy Mc Bui | Physician Assistant | 1530 S Florence Way Unit 312, Aurora, CO 80247 | 2019-02-25 |
| 1639650252 | Jade Golden | Physician Assistant | 101 Founders Pl Ste 109, Aspen, CO 81611-1476 | 2018-08-22 |
| 1861902157 | Hannah Ellen Martin | Physician Assistant | Children's Hospital Colorado 13123 East 16th Avenue, Box 060, Aurora, CO 80045-0600 | 2017-10-02 |
| 1861901878 | Stephanie J Dyck IIi | Physician Assistant | 3800 North York St, Denver, CO 80205-3540 | 2017-09-21 |
| 1932622719 | Brooke Annette Albert | Physician Assistant | 2801 Youngfield St Ste 150, Golden, CO 80401-0209 | 2017-07-24 |
| 1912433400 | Wendy Miller | Physician Assistant | 4041 E Forbes Ct, Greenwood Village, CO 80121-3943 | 2017-05-03 |
| 1154863249 | Zachary A Hitchcock | Physician Assistant | 1107 S Lemay Ave Ste 240, Fort Collins, CO 80524-3959 | 2016-11-07 |
| Find all providers with the same taxonomy | ||||
| City | PUEBLO WEST |
| Zip Code | 81007 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.