Healthcare Provider Details

I. General information

NPI: 1871720540
Provider Name (Legal Business Name): BALL OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

V. Phone/Fax

Practice location:
  • Phone: 765-751-5227
  • Fax: 765-741-2873
Mailing address:
  • Phone: 765-751-5227
  • Fax: 765-741-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JON SCHAEFER
Title or Position: MANAGER - AMBULATORY SERVICES
Credential:
Phone: 765-751-5227