=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144361874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALLINGER MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 N 8TH ST
-----------------------------------------------------
City | BALLINGER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76821-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-365-2125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 463
-----------------------------------------------------
City | BALLINGER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76821-0463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-365-2125
-----------------------------------------------------
Fax | 325-365-9995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. J PAUL REYNOLDS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 325-365-2125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 207Q00000X
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------