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General NPI Number Information
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NPI Number | 1235612235
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Entity Type | Organization
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Legal Business Name | BALANCE MEDICAL, INC.
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 04/26/2020
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Provider Practice Location Address
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Address Line | 1019 WATERWOOD PKWY STE E-14
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City | EDMOND
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State | OK
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Zip | 73034-5332
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Country | US
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Telephone | 405-369-3504
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Fax | 405-337-9639
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Provider Business Mailing Address
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Address Line | 1019 WATERWOOD PKWY STE E-14
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City | EDMOND
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State | OK
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Zip | 73034-5332
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Country | US
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Telephone | 405-369-3504
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Fax | 405-337-9639
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN HENSON
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Credential |
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Telephone | 405-369-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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