1699013284 NPI number — BALANCE INTEGRATIVE MEDICINE, PC

Table of content: (NPI 1699013284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699013284 NPI number — BALANCE INTEGRATIVE MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALANCE INTEGRATIVE MEDICINE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699013284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9001 MEDINAH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68526-9239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 PIONEER WOODS DR
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-7565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VANDER POL
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
402-890-0449

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  815 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com