Provider Demographics
NPI:1134455835
Name:BALL, JACE ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:JACE
Middle Name:ALLEN
Last Name:BALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2600
Mailing Address - Country:US
Mailing Address - Phone:406-228-3400
Mailing Address - Fax:
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-3645
Practice Address - Fax:406-228-3533
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000902403OtherBCBS-MT
MT1134455835Medicaid
MT1134455835OtherMEDICARE