MEDICARE: BALLARD NEIGHBORHOOD DOCTORS PLLC

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	207Q00000X	Family Medicine Physician

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	:	1912184680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALLARD NEIGHBORHOOD DOCTORS PLLC

Provider Business Mailing Address
First Line	:	5416 BARNES AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3839
Country	:	US
Telephone Number	:	206-297-7678
Fax Number	:	206-297-5930

Provider Business Practice Location Address
First Line	:	5416 BARNES AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3839
Country	:	US
Telephone Number	:	206-297-7678
Fax Number	:	206-297-5930

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAULA HARDY
Credential	:
Telephone Number	:	206-297-7678

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	03/17/2015

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