MEDICARE: C L BALLEW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	1888	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730275504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C L BALLEW

Provider Business Mailing Address
First Line	:	115 ATRIUM WAY
Second Line	:	SUITE 232
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6383
Country	:	US
Telephone Number	:	803-788-8484
Fax Number	:	803-788-8499

Provider Business Practice Location Address
First Line	:	115 ATRIUM WAY
Second Line	:	SUITE 232
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6383
Country	:	US
Telephone Number	:	803-788-8484
Fax Number	:	803-788-8499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/08/2008

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Directions to “ C L BALLEW ” Practice Location

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