Provider Demographics
NPI:1790787430
Name:BALLARD AVIATION INC
Entity Type:Organization
Organization Name:BALLARD AVIATION INC
Other - Org Name:EAGLEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-764-3343
Mailing Address - Street 1:6601 PUEBLO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2926
Mailing Address - Country:US
Mailing Address - Phone:800-764-3343
Mailing Address - Fax:316-613-4801
Practice Address - Street 1:6601 PUEBLO DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2926
Practice Address - Country:US
Practice Address - Phone:800-764-3343
Practice Address - Fax:316-613-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9303416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96001920Medicaid
NE=========-00Medicaid
CO96001920Medicaid
COC446248Medicare PIN
NE=========-00Medicaid
KS119996Medicare PIN