Provider Demographics
NPI:1144566167
Name:VALLEY MEDICAL MANAGEMENT OF PAIN INC
Entity Type:Organization
Organization Name:VALLEY MEDICAL MANAGEMENT OF PAIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-699-1000
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0614
Mailing Address - Country:US
Mailing Address - Phone:740-699-1000
Mailing Address - Fax:
Practice Address - Street 1:51342 NATIONAL RD E
Practice Address - Street 2:STE J
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1710
Practice Address - Country:US
Practice Address - Phone:740-699-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006700B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2062360Medicaid