1962089045 NPI number — MS. CYNTHIA LYNN BALCH MSCJ

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 1962089045 NPI number — MS. CYNTHIA LYNN BALCH MSCJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALCH
Provider First Name:
CYNTHIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSCJ
Provider Gender Code:
F

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:
1962089045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 N RICE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41230-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-424-3093
Provider Business Mailing Address Fax Number:
606-638-0032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 N RICE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-424-3093
Provider Business Practice Location Address Fax Number:
606-638-0032
Provider Enumeration Date:
03/25/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00000000000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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