MEDICARE: BALANCED SOLUTION LLC

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	261QH0100X	Health Service Clinic/Center	8878	SC

General Provider Information

NPI Number	:	1679812960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED SOLUTION LLC

Provider Business Mailing Address
First Line	:	420 THE PKWY STE N
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5205
Country	:	US
Telephone Number	:	864-662-7655
Fax Number	:	864-662-7657

Provider Business Practice Location Address
First Line	:	420 THE PKWY STE N
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5205
Country	:	US
Telephone Number	:	864-662-7655
Fax Number	:	864-662-7657

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. WILLIAM SCOTT
Credential	:	M.D.
Telephone Number	:	864-662-7655

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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