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General NPI Number Information
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NPI Number | 1609291459
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Entity Type | Organization
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Legal Business Name | CARRIAGE HOUSE MEDICAL SPECIALTIES
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 116 MECHANIC ST
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City | SPARTANSBURG
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State | PA
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Zip | 16434-1026
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Country | US
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Telephone | 814-654-7334
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Fax | 814-654-7553
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Provider Business Mailing Address
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Address Line | 116 MECHANIC ST
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City | SPARTANSBURG
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State | PA
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Zip | 16434-1026
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Country | US
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Telephone | 814-654-7334
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Fax | 814-654-7553
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA M BALMER
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Credential |
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Telephone | 814-654-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | OS007522L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | OS015735
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0S015735
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS007522L
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License Number State | PA
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