1649239005 NPI number — KATHARINE J BALBUENA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649239005 NPI number — KATHARINE J BALBUENA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHARINE J BALBUENA MD
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:
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:
1649239005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-927-6640
Provider Business Mailing Address Fax Number:
903-927-6643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 SOUTH WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-927-6640
Provider Business Practice Location Address Fax Number:
903-927-6643
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALBUENA
Authorized Official First Name:
KATHARINE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-927-6640

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0030QD . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 029577601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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