Organization
K. W. BALLENTINE, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
K W BALLENTINE MD (PRESIDENT)
(803) 534-0053
Entity
Organization
Contact information
Practice address
420 THOMSON CIR, ABBEVILLE, SC 29620-5656
(803) 534-0053
(803) 534-0291
Mailing address
PO BOX 2201, ORANGEBURG, SC 29116-2201
(803) 534-0053
(803) 534-0291
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C11223
RR MEDICARE
GA
Enumeration date
11/16/2006
Last updated
11/08/2010
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