# BALLARD GYNECOLOGY PROF LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336589936
- **Authorized official:** DR. MARK C. BALLARD M.D. (OWNER)
- **Authorized official phone:** (605) 791-4442

## Contact information

- **Practice address:** 208 FEDERAL AVE, RAPID CITY, SD 57702-2326
- **Practice address phone:** (605) 791-4442
- **Practice address fax:** (605) 791-4449
- **Mailing address:** 208 FEDERAL AVE, RAPID CITY, SD 57702-2326
- **Mailing address phone:** (605) 791-4442
- **Mailing address fax:** (605) 791-4449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 4683 | SD | Yes |

## Other

- **Enumeration date:** 06/27/2013
- **Last updated:** 06/27/2013