Provider Demographics
NPI:1649222589
Name:HARBOR TOWN PULMONARY, LLC
Entity Type:Organization
Organization Name:HARBOR TOWN PULMONARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-573-2255
Mailing Address - Street 1:12-A FARMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7755
Mailing Address - Country:US
Mailing Address - Phone:843-573-2255
Mailing Address - Fax:843-573-2291
Practice Address - Street 1:12-A FARMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7755
Practice Address - Country:US
Practice Address - Phone:843-573-2255
Practice Address - Fax:843-573-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3875Medicaid
SCGP3875Medicaid
SC7824Medicare PIN