=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417191685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN VINCENT BALL CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 10/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 HOSPITAL RD PLYMOUTH ANESTHESIA
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03264-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-536-1120
-----------------------------------------------------
Fax | 603-238-6409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 706
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03264-0706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-481-8757
-----------------------------------------------------
Fax | 603-238-2163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 062420-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------