MEDICARE: BALANCE DIAGNOSTICS LLC

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1437246089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	2195 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:	850-522-4770
Fax Number	:	850-522-4760

Authorized Official
Title or Position	:	VICE PRRESIDENT
Name	:	MR. JAMES JOHN PILOCO
Credential	:
Telephone Number	:	914-949-9276

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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Directions to “BALANCE DIAGNOSTICS LLC ” Practice Location

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