=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801909718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK C. BALLARD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AMMC WOMEN'S CLINIC 1110 W. KINGSHIGHWAY
-----------------------------------------------------
City | PARAGOULD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72450-4164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-205-2000
-----------------------------------------------------
Fax | 870-205-2001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ARKANSAS METHODIST MEDICAL CENTER 900 W KINGSHIGHWAY
-----------------------------------------------------
City | PARAGOULD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-239-7000
-----------------------------------------------------
Fax | 870-239-7484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 4683
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | T2025-282
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD52141
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | E-19987
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------