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Contact Information

JACQUELYN HALL-DAVIS,M.D. LTD
1669 WINDHAM WAY
SUITE B
O'FALLON, IL62269-3072
 Phone: 618-622-9240
 Fax: 618-622-9241
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for JACQUELYN HALL-DAVIS,M.D. LTD

NPI Number 1699173542
LBN Legal business name JACQUELYN HALL-DAVIS,M.D. LTD
Authorized official JACQUELYN HALL-DAVIS - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 12/09/2014
Last updated 12/09/2014 - About 11 years ago
Identifiers
IL License # 036080270
IL Medicaid 036080270
IL Other 540653 TRICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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