MEDICARE: BALANCE DIAGNOSTIC MC, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	NOT APPLICABLE	TX

General Provider Information

NPI Number	:	1265523948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE DIAGNOSTIC MC, LLP

Provider Business Mailing Address
First Line	:	4141 SOUTHWEST FWY
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77027-7313
Country	:	US
Telephone Number	:	713-223-1800
Fax Number	:	713-669-0088

Provider Business Practice Location Address
First Line	:	4141 SOUTHWEST FWY
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77027-7313
Country	:	US
Telephone Number	:	713-223-1800
Fax Number	:	713-669-0088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARY LOUISE WESSELS
Credential	:
Telephone Number	:	713-223-1800

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/19/2007

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