MEDICARE: SCIOTO VALLEY UROLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1346254976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCIOTO VALLEY UROLOGY INC

Provider Business Mailing Address
First Line	:	500 E MAIN ST
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5369
Country	:	US
Telephone Number	:	614-222-3369
Fax Number	:	614-224-1208

Provider Business Practice Location Address
First Line	:	500 E MAIN ST
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5369
Country	:	US
Telephone Number	:	614-222-3369
Fax Number	:	614-224-1208

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JOHN D BALUCH
Credential	:	MD
Telephone Number	:	614-222-3369

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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Directions to “SCIOTO VALLEY UROLOGY INC ” Practice Location

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