Provider Demographics
NPI:1164691051
Name:REFINED BALANCE
Entity Type:Organization
Organization Name:REFINED BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-646-6700
Mailing Address - Street 1:12315 JUDSON RD STE 318
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3265
Mailing Address - Country:US
Mailing Address - Phone:210-599-9355
Mailing Address - Fax:210-646-6705
Practice Address - Street 1:12315 JUDSON RD STE 318
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3265
Practice Address - Country:US
Practice Address - Phone:210-599-9355
Practice Address - Fax:210-646-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3250261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID