Basic Information
Provider Information | |||||||||
NPI: | 1235426453 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DR BALA AND ASSOCIATES A MAJOR HEALTH PARTNER LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DR BALA AND ASSOCIATES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1626 E STATE ROAD 44 | ||||||||
Address2: |   | ||||||||
City: | SHELBYVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 461764026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3174212012 | ||||||||
FaxNumber: | 3173981852 | ||||||||
Practice Location | |||||||||
Address1: | 2158 INTELLIPLEX DR | ||||||||
Address2: | SUITE 106 | ||||||||
City: | SHELBYVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 461768548 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3174212012 | ||||||||
FaxNumber: | 3173981852 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2011 | ||||||||
LastUpdateDate: | 07/08/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCHENE | ||||||||
AuthorizedOfficialFirstName: | MARY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PFS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3174212012 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.