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NPI Code Detail

MEDICARE: MR. CHARLES BALICAT

MEDICARE: MR. CHARLES BALICAT
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
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1356609275
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES BALICAT
Provider Business Mailing Address
First Line : 4180 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5074
Country : US
Telephone Number : 702-486-7538
Fax Number :
Provider Business Practice Location Address
First Line : 4180 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5074
Country : US
Telephone Number : 702-486-7538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2012
Last Update Date : 06/03/2015

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