Healthcare Provider Details

I. General information

NPI: 1134455835
Provider Name (Legal Business Name): JACE ALLEN BALL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 3RD ST S
GLASGOW MT
59230-2604
US

IV. Provider business mailing address

221 5TH AVE S
GLASGOW MT
59230-2600
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-3645
  • Fax: 406-228-3533
Mailing address:
  • Phone: 406-228-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number591
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: