Provider Demographics
NPI:1518167105
Name:BALLET MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BALLET MEDICAL CORPORATION
Other - Org Name:CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-2022
Mailing Address - Street 1:806 N 31ST ST
Mailing Address - Street 2:# D
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3945
Mailing Address - Country:US
Mailing Address - Phone:318-388-2022
Mailing Address - Fax:318-388-2023
Practice Address - Street 1:806 N 31ST ST
Practice Address - Street 2:# D
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3945
Practice Address - Country:US
Practice Address - Phone:318-388-2022
Practice Address - Fax:318-388-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5196449-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies