Provider Demographics
NPI:1073672341
Name:JOHN E BALMER JR., DO
Entity Type:Organization
Organization Name:JOHN E BALMER JR., DO
Other - Org Name:CANADOHTA LAKE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-654-7334
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434
Mailing Address - Country:US
Mailing Address - Phone:814-654-7334
Mailing Address - Fax:
Practice Address - Street 1:35255 BROWN HILL RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438
Practice Address - Country:US
Practice Address - Phone:814-694-2339
Practice Address - Fax:814-694-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001511070Medicaid
PA870298OtherBLUE SHIELD
PA001511070Medicaid
393873Medicare Oscar/Certification