Healthcare Provider Details

I. General information

NPI: 1508116278
Provider Name (Legal Business Name): ONCALL MOBILE MEDICAL AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 W WILKINSON BLVD SUITE 241
BELMONT NC
28012-2858
US

IV. Provider business mailing address

6428 W WILKINSON BLVD SUITE 241
BELMONT NC
28012-2858
US

V. Phone/Fax

Practice location:
  • Phone: 704-747-2262
  • Fax: 877-934-7633
Mailing address:
  • Phone: 704-747-2262
  • Fax: 877-934-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEI BALL
Title or Position: CMO, MANAGER
Credential: MD
Phone: 704-747-2262