MEDICARE: LEWIS NELSON BALLARD III CRNA

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	367500000X	Certified Registered Nurse Anesthetist	C00410	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00373018	OTHER		RR MEDICARE GROUP CK 6327

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59408	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1760452056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS NELSON BALLARD III CRNA

Provider Business Mailing Address
First Line	:	PO BOX 22390
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71903
Country	:	US
Telephone Number	:	800-235-1415
Fax Number	:	913-234-1108

Provider Business Practice Location Address
First Line	:	1636 HIGDON FERRY RD
Second Line	:	MLK BLVD
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6912
Country	:	US
Telephone Number	:	501-520-2000
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/28/2008

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