Provider Demographics
NPI:1235612235
Name:BALANCE MEDICAL, INC.
Entity Type:Organization
Organization Name:BALANCE MEDICAL, INC.
Other - Org Name:BALANCE MEDICAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-369-3504
Mailing Address - Street 1:1019 WATERWOOD PKWY STE E-14
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5332
Mailing Address - Country:US
Mailing Address - Phone:405-369-3504
Mailing Address - Fax:405-337-9639
Practice Address - Street 1:1019 WATERWOOD PKWY STE E-14
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5332
Practice Address - Country:US
Practice Address - Phone:405-369-3504
Practice Address - Fax:405-337-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty