1407996663 NPI number — MELODIE HOPE BALLMAN R NCST, CNIM

Table of content: MELODIE HOPE BALLMAN R NCST, CNIM (NPI 1407996663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407996663 NPI number — MELODIE HOPE BALLMAN R NCST, CNIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLMAN
Provider First Name:
MELODIE
Provider Middle Name:
HOPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R NCST, CNIM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407996663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10777 RICHMOND AVE
Provider Second Line Business Mailing Address:
618
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77042-4914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-885-1595
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 SOLDIERS FIELD DR
Provider Second Line Business Practice Location Address:
ARGOS IOM SERVICES
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-4053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-313-1355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

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: 246ZE0600X , with the licence number:  CNIM 0654 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 246ZE0600X , with the licence number: RNCST 0520 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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