Basic Information
| Provider Information | |||||||||
| NPI: | 1417188525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALM INTERNATIONAL HEALTH CARE CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 661495 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352661495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367482025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345782357 | ||||||||
| FaxNumber: | 3342955596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | CRAIG | ||||||||
| AuthorizedOfficialFirstName: | KETURAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3342954144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 291 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | DQ1809 | 01 | AL | RAILROAD MEDICARE | OTHER | 113457 | 05 | AL | MEDICAID | 1417188525 | 01 | AL | TRICARE | OTHER |