Hallstrom, Craig Kenneth

Hallstrom, Craig Kenneth is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine, which is considered as his primary health care specialty. Hallstrom, Craig Kenneth can be contacted via phone (601) 815-8173.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-8173
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 18514 Mississippi

Profile Details

NPI number 1598709503
LBN Legal business name Hallstrom, Craig Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Apr 1st, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598709503 NPPES
Mississippi Other 512I370060 MEDICARE PTAN
Mississippi MEDICAID 07076371 MEDICARE PTAN
Mississippi MEDICAID 1603767 MEDICARE PTAN
Mississippi MEDICAID 157470 MEDICARE PTAN

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