Healthcare Provider Details

I. General information

NPI: 1932768553
Provider Name (Legal Business Name): ANTHONY B BALENTINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HITCHING POST RD
GRANTS PASS OR
97526-9710
US

IV. Provider business mailing address

300 W MAIN ST
MEDFORD OR
97501-2756
US

V. Phone/Fax

Practice location:
  • Phone: 541-237-5067
  • Fax: 541-479-2370
Mailing address:
  • Phone: 541-772-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: