Healthcare Provider Details

I. General information

NPI: 1790787430
Provider Name (Legal Business Name): BALLARD AVIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 PUEBLO DR
WICHITA KS
67209-2926
US

IV. Provider business mailing address

6601 PUEBLO DR
WICHITA KS
67209-2926
US

V. Phone/Fax

Practice location:
  • Phone: 800-764-3343
  • Fax: 316-613-4801
Mailing address:
  • Phone: 800-764-3343
  • Fax: 316-613-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number930
License Number StateKS

VIII. Authorized Official

Name: MRS. DAWN ZON
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 800-764-3343