Provider Demographics
NPI:1285061127
Name:BALL HEALTHCARE-JEFFERSON, INC.
Entity type:Organization
Organization Name:BALL HEALTHCARE-JEFFERSON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-433-9801
Mailing Address - Street 1:1 SOUTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1210
Mailing Address - Country:US
Mailing Address - Phone:251-433-9801
Mailing Address - Fax:
Practice Address - Street 1:1250 JEFF GERMANY PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-4484
Practice Address - Country:US
Practice Address - Phone:205-796-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation