Provider Demographics
NPI:1417188525
Name:BALM INTERNATIONAL HEALTH CARE CENTERS, LLC
Entity Type:Organization
Organization Name:BALM INTERNATIONAL HEALTH CARE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KETURAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-295-4144
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-2025
Practice Address - Country:US
Practice Address - Phone:334-578-2357
Practice Address - Fax:334-295-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL291213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDQ1809OtherRAILROAD MEDICARE
AL113457Medicaid
AL1417188525OtherTRICARE
AL102G703261Medicare PIN