Basic Information
| Provider Information | |||||||||
| NPI: | 1134207244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLARD | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 BISHOP LN STE 402 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402181922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024562677 | ||||||||
| FaxNumber: | 5024582163 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 BISHOP LN STE 402 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402181922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024582677 | ||||||||
| FaxNumber: | 5024582163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 26543 | KY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 373344400 | 01 | KY | DOL | OTHER | 1127947 | 01 | KY | PASSPORT HEALTH | OTHER | 000000174219 | 01 | KY | ANTHEM | OTHER | 5729195 | 01 | KY | AETNA | OTHER |