Provider Demographics
NPI:1356656870
Name:BALLE WELLNESS CONSORTIUM, INC.
Entity Type:Organization
Organization Name:BALLE WELLNESS CONSORTIUM, INC.
Other - Org Name:BALLE BLISS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:GURMANJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHATHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-758-2777
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1018
Mailing Address - Country:US
Mailing Address - Phone:281-758-2777
Mailing Address - Fax:281-758-2843
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 270
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1018
Practice Address - Country:US
Practice Address - Phone:281-758-2777
Practice Address - Fax:281-758-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty