Healthcare Provider Details

I. General information

NPI: 1881664050
Provider Name (Legal Business Name): ALGIMANTAS BALCIUNAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MARSHALL WAY MARSHALL MEDICAL CENTER
PLACERVILLE CA
95667
US

IV. Provider business mailing address

PO BOX 707 BILLING OFFICE, PLACERVILLE RADIOLOGY MEDICAL GROUP
PLACERVILLE CA
95667-0707
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-1441
  • Fax:
Mailing address:
  • Phone: 530-626-1166
  • Fax: 530-626-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberG10603
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG10603
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG10603
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG10603
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberG10603
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG10603
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License NumberG10603
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG10603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: