MEDICARE: HARBOR TOWN PULMONARY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	13794	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649222589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR TOWN PULMONARY, LLC

Provider Business Mailing Address
First Line	:	12-A FARMFIELD AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7755
Country	:	US
Telephone Number	:	843-573-2255
Fax Number	:	843-573-2291

Provider Business Practice Location Address
First Line	:	12-A FARMFIELD AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7755
Country	:	US
Telephone Number	:	843-573-2255
Fax Number	:	843-573-2291

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES BALL
Credential	:	M.D.
Telephone Number	:	843-573-2255

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/21/2011

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