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General NPI Number Information
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NPI Number | 1518167105
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Entity Type | Organization
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Legal Business Name | BALLET MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 806 N 31ST ST # D
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City | MONROE
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State | LA
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Zip | 71201-3945
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Country | US
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Telephone | 318-388-2022
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Fax | 318-388-2023
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Provider Business Mailing Address
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Address Line | 806 N 31ST ST # D
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City | MONROE
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State | LA
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Zip | 71201-3945
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Country | US
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Telephone | 318-388-2022
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Fax | 318-388-2023
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS OCTAVIA J TAYLOR
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Credential |
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Telephone | 318-388-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5196449-001
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License Number State | LA
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