1386614345 NPI number — ELPIDIA H BALBASTRO M.D.

Table of content: ELPIDIA H BALBASTRO M.D. (NPI 1386614345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386614345 NPI number — ELPIDIA H BALBASTRO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALBASTRO
Provider First Name:
ELPIDIA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1386614345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-942-7898
Provider Business Mailing Address Fax Number:
225-765-9196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 HOSPITAL DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELOUSAS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70570-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-942-7898
Provider Business Practice Location Address Fax Number:
337-942-7808
Provider Enumeration Date:
01/24/2006

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: 207RH0003X , with the licence number:  J7417 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 40557 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 036085269 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: MD0000041542 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 036085269 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 309969 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5080652 . This is a "AETNA PROVIDER PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0910609 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 271459 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100021930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036085269 . This is a "IL DEPT OF PUBLIC AID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: G09596 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020248399 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1234850 . This is a "CHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123712 . This is a "HEALTH ALLIANCE-PHP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3827817 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000236043 . This is a "UNISON HEALTH PLAN MEDICARE ADVANTAGE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00000504506 . This is a "ANTHEM BCBS KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 41960 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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