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General NPI Number Information
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NPI Number | 1932105996
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Entity Type | Organization
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Legal Business Name | JOHN BALKO AND ASSOCIATES INC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 102 NORTH KEEL RIDGE ROAD
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City | HERMITAGE
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State | PA
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Zip | 16148-3440
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Country | US
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Telephone | 866-758-4862
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Fax | 330-758-4886
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Provider Business Mailing Address
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Address Line | 102 NORTH KEEL RIDGE ROAD
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City | HERMITAGE
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State | PA
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Zip | 16148-3440
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Country | US
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Telephone | 866-758-4862
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Fax | 330-758-4886
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | JOHN BALKO
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Credential | AU.D.
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Telephone | 866-758-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE6726-T
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36-00-3012-I
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT-001085-L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34-00-4454D
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License Number State | PA
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