Provider Demographics
NPI:1912184680
Name:BALLARD NEIGHBORHOOD DOCTORS PLLC
Entity Type:Organization
Organization Name:BALLARD NEIGHBORHOOD DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-297-7678
Mailing Address - Street 1:5416 BARNES AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3839
Mailing Address - Country:US
Mailing Address - Phone:206-297-7678
Mailing Address - Fax:206-297-5930
Practice Address - Street 1:5416 BARNES AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3839
Practice Address - Country:US
Practice Address - Phone:206-297-7678
Practice Address - Fax:206-297-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0244819Medicaid