MEDICARE: BALANCED HEALTH MEDICAL CENTER

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	175F00000X	Naturopath

General Provider Information

NPI Number	:	1326763509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED HEALTH MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2024 WELLS MANOR AVE
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-4230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5749 S 21ST TER
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3450
Country	:	US
Telephone Number	:	240-389-5734
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIRT TYSON
Credential	:
Telephone Number	:	240-389-5734

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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Directions to “BALANCED HEALTH MEDICAL CENTER ” Practice Location

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