| Ballard Medical Corporation | |
|
1115 Whiskeytown Ct Suite B Redding CA 96001-0227 | |
| (530) 244-9750 | |
| (530) 244-0960 |
| Full Name | Ballard Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1115 Whiskeytown Ct, Redding, California |
| Authorized Official Name and Position | Morris Robert Ballard (PRESIDENT) |
| Authorized Official Contact | 5302449750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ballard Medical Corporation 1115 Whiskeytown Ct Suite B Redding CA 96001-0227 Ph: (530) 244-9750 | Ballard Medical Corporation 1115 Whiskeytown Ct Suite B Redding CA 96001-0227 Ph: (530) 244-9750 |
| NPI Number | 1629149984 |
|---|---|
| Provider Enumeration Date | 11/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5496817306 |
|---|---|
| Medicare Enrollment ID | O20081230000405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629149984 | NPI | - | NPPES |
| ZZZ89207Z | Other | CA | BLUE SHIELD PROVIDER # |
| GR0001720 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G017510 (California) | Primary |
| 207Q00000X | Family Medicine | G14717 (California) | Secondary |
| Provider Name | Morris R Ballard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881716256 PECOS PAC ID: 2567524473 Enrollment ID: I20081230000437 |
| Provider Name | Diana M Ballard |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1942322326 PECOS PAC ID: 5193887008 Enrollment ID: I20081230000461 |
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