Provider Demographics
NPI:1326827874
Name:ABE BALSAMO & CO
Entity Type:Organization
Organization Name:ABE BALSAMO & CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BALSAMO
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:575-776-4853
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:ARROYO SECO
Mailing Address - State:NM
Mailing Address - Zip Code:87514-0302
Mailing Address - Country:US
Mailing Address - Phone:575-776-4853
Mailing Address - Fax:575-205-0311
Practice Address - Street 1:45 JUAN MARTINEZ ROAD
Practice Address - Street 2:
Practice Address - City:ARROYO SECO
Practice Address - State:NM
Practice Address - Zip Code:87514
Practice Address - Country:US
Practice Address - Phone:575-776-4853
Practice Address - Fax:575-205-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty