1811291750 NPI number — MRS. CAROLE BENTLEY BALL L.P.C.

Table of content: MRS. CAROLE BENTLEY BALL L.P.C. (NPI 1811291750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811291750 NPI number — MRS. CAROLE BENTLEY BALL L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALL
Provider First Name:
CAROLE
Provider Middle Name:
BENTLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALL
Provider Other First Name:
CAROLE
Provider Other Middle Name:
BENTLEY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.P.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811291750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10320 WOODVIEW CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-8786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-814-9893
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5203 SHARON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-554-9900
Provider Business Practice Location Address Fax Number:
704-554-9956
Provider Enumeration Date:
01/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  8312 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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