=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912184680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALLARD NEIGHBORHOOD DOCTORS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2008
-----------------------------------------------------
Last Update Date | 03/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5416 BARNES AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-297-7678
-----------------------------------------------------
Fax | 206-297-5930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5416 BARNES AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-297-7678
-----------------------------------------------------
Fax | 206-297-5930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | PAULA HARDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-297-7678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------