Healthcare Provider Details

I. General information

NPI: 1093629990
Provider Name (Legal Business Name): MICHAEL BALENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BROWN ST
HAMILTON TX
76531-1518
US

IV. Provider business mailing address

541 US HIGHWAY 183 S
GOLDTHWAITE TX
76844-3416
US

V. Phone/Fax

Practice location:
  • Phone: 254-386-1600
  • Fax:
Mailing address:
  • Phone: 325-200-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number757505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: