Organization
BALLARD GYNECOLOGY PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK C. BALLARD M.D. (OWNER)
(605) 791-4442
Entity
Organization
Contact information
Practice address
208 FEDERAL AVE, RAPID CITY, SD 57702-2326
(605) 791-4442
(605) 791-4449
Mailing address
208 FEDERAL AVE, RAPID CITY, SD 57702-2326
(605) 791-4442
(605) 791-4449
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4683
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008113
BCBS INDIVIDUAL NUMBER
SD
05
—
117665000
—
WY
05
—
6200920
—
SD
Enumeration date
06/27/2013
Last updated
06/27/2013
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