1356656870 NPI number — BALLE WELLNESS CONSORTIUM, INC.

Table of content: (NPI 1356656870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356656870 NPI number — BALLE WELLNESS CONSORTIUM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALLE WELLNESS CONSORTIUM, INC.
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:
BALLE BLISS
Provider Other Organization Name Type Code:
3
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:
1356656870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13611 SKINNER RD
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77429-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-758-2777
Provider Business Mailing Address Fax Number:
281-758-2843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13611 SKINNER RD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-758-2777
Provider Business Practice Location Address Fax Number:
281-758-2843
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHATHA
Authorized Official First Name:
GURMANJIT
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
281-758-2777

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M3395 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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