Basic Information
| Provider Information | |||||||||
| NPI: | 1265523948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALANCE DIAGNOSTIC MC, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4141 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770277313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132231800 | ||||||||
| FaxNumber: | 7136690088 | ||||||||
| Practice Location | |||||||||
| Address1: | 4141 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770277313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132231800 | ||||||||
| FaxNumber: | 7136690088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | WESSELS | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | LOUISE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7132231800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | NOT APPLICABLE | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.