Provider Demographics
NPI:1043665508
Name:NORTHWOODS FAMILY ORTHOPAEDICS, S.C.
Entity Type:Organization
Organization Name:NORTHWOODS FAMILY ORTHOPAEDICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, BC
Authorized Official - Phone:715-561-4795
Mailing Address - Street 1:502 COPPER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1385
Mailing Address - Country:US
Mailing Address - Phone:715-561-4795
Mailing Address - Fax:715-561-4796
Practice Address - Street 1:502 COPPER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1385
Practice Address - Country:US
Practice Address - Phone:715-561-4795
Practice Address - Fax:715-561-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103428375Medicaid
WI32226100Medicaid
WI000044110Medicare PIN
MI103428375Medicaid
WI000028025Medicare PIN
MION80670Medicare PIN