Provider Demographics
NPI:1508001686
Name:CHARLES H BALLARD INC
Entity Type:Organization
Organization Name:CHARLES H BALLARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-891-6001
Mailing Address - Street 1:2439 S KIHEI RD
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7283
Mailing Address - Country:US
Mailing Address - Phone:808-891-6001
Mailing Address - Fax:808-891-1006
Practice Address - Street 1:2439 S KIHEI RD
Practice Address - Street 2:SUITE 206A
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7283
Practice Address - Country:US
Practice Address - Phone:808-891-6001
Practice Address - Fax:808-891-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100199Medicare PIN