Provider Demographics
NPI:1588740799
Name:ROY W HALLMAN
Entity type:Organization
Organization Name:ROY W HALLMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-862-7654
Mailing Address - Street 1:13948 S HOXIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-2121
Mailing Address - Country:US
Mailing Address - Phone:708-862-7654
Mailing Address - Fax:708-862-7664
Practice Address - Street 1:13948 S HOXIE AVENUE
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2121
Practice Address - Country:US
Practice Address - Phone:708-862-7654
Practice Address - Fax:708-862-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid