Provider Demographics
NPI:1275586893
Name:MICHAEL T. BALCH, MD PA
Entity Type:Organization
Organization Name:MICHAEL T. BALCH, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TOL
Authorized Official - Last Name:BALCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-799-5203
Mailing Address - Street 1:3805 22ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1142
Mailing Address - Country:US
Mailing Address - Phone:806-799-5203
Mailing Address - Fax:806-799-5205
Practice Address - Street 1:3805 22ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1142
Practice Address - Country:US
Practice Address - Phone:806-799-5203
Practice Address - Fax:806-799-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13103Medicare UPIN
TX00553XMedicare PIN
TXDC8073Medicare PIN