Provider Demographics
NPI:1285196303
Name:BECOMING BALANCED PC
Entity Type:Organization
Organization Name:BECOMING BALANCED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-205-4533
Mailing Address - Street 1:3453 INTERSTATE BLVD S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2213
Mailing Address - Country:US
Mailing Address - Phone:701-540-5487
Mailing Address - Fax:701-205-4593
Practice Address - Street 1:3125 41ST ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8666
Practice Address - Country:US
Practice Address - Phone:701-371-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty