Provider Demographics
NPI:1821219197
Name:BALLANCE, JOHN OWEN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:OWEN
Last Name:BALLANCE
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:PO BOX 2
Mailing Address - Street 2:1248 HUFFMAN MILL ROAD SUITE 200
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0002
Mailing Address - Country:US
Mailing Address - Phone:336-395-1301
Mailing Address - Fax:336-226-5093
Practice Address - Street 1:4030 OAKS PROFESSIONAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8491
Practice Address - Country:US
Practice Address - Phone:336-395-1301
Practice Address - Fax:336-226-5093
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1211237700000X
NC6716231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413051Medicaid
NC1821219197OtherBCBS NC
NC2699705Medicare PIN