1710276340 NPI number — DR. ROBERT THOMSON BALL JR. MD MPH FACP

Table of content: DR. ROBERT THOMSON BALL JR. MD MPH FACP (NPI 1710276340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710276340 NPI number — DR. ROBERT THOMSON BALL JR. MD MPH FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALL
Provider First Name:
ROBERT
Provider Middle Name:
THOMSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD MPH FACP
Provider Gender Code:
M

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:
1710276340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4050 BRIDGE VIEW DRIVE #600
Provider Second Line Business Mailing Address:
SC DEPARTMENT OF HEALTH & ENVIRONMENTAL CONTROL (DHEC)
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29405-7464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-953-0042
Provider Business Mailing Address Fax Number:
843-953-0051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 BRIDGE VIEW DRIVE
Provider Second Line Business Practice Location Address:
#600- SC DHEC
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405-7464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-953-0042
Provider Business Practice Location Address Fax Number:
843-953-0051
Provider Enumeration Date:
04/05/2011

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: 207RI0200X , with the licence number:  SC 7420 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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