Provider Demographics
NPI:1417644865
Name:BALLAS, ADAM THOMAS
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:BALLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LORAMIE
Mailing Address - State:OH
Mailing Address - Zip Code:45845-9398
Mailing Address - Country:US
Mailing Address - Phone:937-489-7948
Mailing Address - Fax:
Practice Address - Street 1:541 ELIZABETH CT
Practice Address - Street 2:
Practice Address - City:FORT LORAMIE
Practice Address - State:OH
Practice Address - Zip Code:45845-9398
Practice Address - Country:US
Practice Address - Phone:937-489-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide