MEDICARE: JOHN BALKO AND ASSOCIATES INC

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	152W00000X	Optometrist	OE6726-T	PA
2	213E00000X	Podiatrist	36-00-3012-I	PA
3	231H00000X	Audiologist	AT-001085-L	PA
4	335E00000X	Prosthetic/Orthotic Supplier
5	207Q00000X	Family Medicine Physician	34-00-4454D	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	DO1166	OTHER	WV	RAILROAD MEDICARE
12	1150680001	OTHER	OH	MEDICARE DME
13	DO8546	OTHER	KS	RAILROAD MEDICARE
21	DG3107	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	39377011	OTHER	KS	BCBS KANSAS
5	817220	OTHER	PA	BLUE CROSS
6	0589118	OTHER	OH	AETNA HMO
7	1500751	OTHER	PA	GATEWAY PA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	891755	OTHER	PA	BLUE CROSS
11	000817313	OTHER	WV	BCBS WEST VIRGINIA
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	0589118	OTHER		AETNA
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	000000361347	OTHER		ANTHEM SENIOR ADVANTAGE
18	001547617	OTHER	PA	BLUE CROSS
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	817050	OTHER	PA	BLUE CROSS
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932105996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN BALKO AND ASSOCIATES INC

Provider Business Mailing Address
First Line	:	102 NORTH KEEL RIDGE ROAD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	866-758-4862
Fax Number	:	330-758-4886

Provider Business Practice Location Address
First Line	:	102 NORTH KEEL RIDGE ROAD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	866-758-4862
Fax Number	:	330-758-4886

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	JOHN BALKO
Credential	:	AU.D.
Telephone Number	:	866-758-4862

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	01/31/2013

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