1235426453 NPI number — DR BALA AND ASSOCIATES A MAJOR HEALTH PARTNER LLC

Table of content: DR. AMANDA COFER YUNKER DO (NPI 1386799583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235426453 NPI number — DR BALA AND ASSOCIATES A MAJOR HEALTH PARTNER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR BALA AND ASSOCIATES A MAJOR HEALTH PARTNER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1235426453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 E STATE ROAD 44
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBYVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46176-4026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-421-2012
Provider Business Mailing Address Fax Number:
317-398-1852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2158 INTELLIPLEX DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-421-2012
Provider Business Practice Location Address Fax Number:
317-398-1852
Provider Enumeration Date:
07/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCHENE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PFS MANAGER
Authorized Official Telephone Number:
317-421-2012

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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