1932105996 NPI number — JOHN BALKO AND ASSOCIATES INC

Table of content: (NPI 1932105996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932105996 NPI number — JOHN BALKO AND ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN BALKO AND ASSOCIATES 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:
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:
1932105996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 NORTH KEEL RIDGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-3440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-758-4862
Provider Business Mailing Address Fax Number:
330-758-4886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 NORTH KEEL RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-758-4862
Provider Business Practice Location Address Fax Number:
330-758-4886
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BALKO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
866-758-4862

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE6726-T , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 34-00-4454D , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 36-00-3012-I , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AT-001085-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007545590017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007545590020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2068337 . This is a "MEDICAID DME OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 39377011 . This is a "BCBS KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 817220 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0589118 . This is a "AETNA HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1500751 . This is a "GATEWAY PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3810014011 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891755 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DO1166 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000817313 . This is a "BCBS WEST VIRGINIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1150680001 . This is a "MEDICARE DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DO8546 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: OP11670 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0589118 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 504036005 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000361347 . This is a "ANTHEM SENIOR ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001547617 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200552880A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 817050 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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