1417996018 NPI number — DR. LISA ONA BALLEHR D.O.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417996018 NPI number — DR. LISA ONA BALLEHR D.O.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BALLEHR

Provider First Name:

LISA

Provider Middle Name:

ONA

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.O.

Provider Gender Code:

F

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:

1417996018

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/26/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

308 N PETERS RD

Provider Second Line Business Mailing Address:

STE. 225

Provider Business Mailing Address City Name:

KNOXVILLE

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37922-2356

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

865-560-8561

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

8 CADILLAC DR

Provider Second Line Business Practice Location Address:

SUITE 200

Provider Business Practice Location Address City Name:

BRENTWOOD

Provider Business Practice Location Address State Name:

TN

Provider Business Practice Location Address Postal Code:

37027-5087

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

615-376-7370

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  3876 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 44659 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: OP00002102 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 4380 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 25MB08084600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 24.000006 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 20A9111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 3875 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 036-115593 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: D026498 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: OS010183L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 66 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: TM00006 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 1202 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 00AX91110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 01287729 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 812645 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: 8942215 . This is a "L&I CVCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8461238 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 103I303676 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: P00302231 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1417996018 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
• Identifier: P00158822 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".