BALLEHR, LISA ONA (DO)

Provider Demographics

• NPI: 1417996018
• Name: BALLEHR, LISA ONA (DO)
• Entity Type: Individual
• Prefix: DR
• First Name: LISA
• Middle Name: ONA
• Last Name: BALLEHR
• Gender: F
• Credentials: DO
• Mailing Address - Street 1: 308 N PETERS RD
• Mailing Address - Street 2: STE. 225
• Mailing Address - City: KNOXVILLE
• Mailing Address - State: TN
• Mailing Address - Zip Code: 37922-2356
• Mailing Address - Country: US
• Mailing Address - Phone: 865-560-8561
• Practice Address - Street 1: 8 CADILLAC DR
• Practice Address - Street 2: SUITE 200
• Practice Address - City: BRENTWOOD
• Practice Address - State: TN
• Practice Address - Zip Code: 37027-5087
• Practice Address - Country: US
• Practice Address - Phone: 615-376-7370
• Is Sole Proprietor?: No
• Enumeration Date: 2006-06-06
• Last Update Date: 2013-03-26

Provider Licenses

State	License ID	Taxonomies
AZ	3876	2085R0202X
CO	44659	2085R0202X
WA	OP00002102	2085R0202X
OK	4380	2085R0202X
NJ	25MB08084600	2085R0202X
OH	24.000006	2085R0202X
CA	20A9111	2085R0202X
AK	3875	2085R0202X
IL	036-115593	2085R0202X
OR	D026498	2085R0202X
PA	OS010183L	2085R0202X
MT	66	2085R0202X
TX	TM00006	2085R0202X
NV	1202	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	00AX91110	Medicaid
CO	01287729	Medicaid
AZ	812645	Medicaid
WA	8942215	Other	L&I CVCP
WA	8461238	Medicaid
TN	103I303676	Medicaid
CA	P00302231	Other	RAILROAD MEDICARE
NV	1417996018	Medicaid
AZ	P00158822	Other	RAILROAD MEDICARE
NV	1417996018	Medicaid
TN	103I303676	Medicare PIN
CA	AT635V	Medicare PIN
CA	AT635B	Medicare PIN
CA	AT635H	Medicare PIN
CA	AT635J	Medicare PIN
CA	AT635U	Medicare PIN
CA	AT635X	Medicare PIN
CA	020A91110	Medicare PIN
CO	01287729	Medicaid
CA	AT635P	Medicare PIN
CA	AT635T	Medicare PIN
CA	AT635Z	Medicare PIN
CA	P00302231	Other	RAILROAD MEDICARE
CA	AT635M	Medicare PIN
CA	AT635N	Medicare PIN
CA	AT635S	Medicare PIN
CA	AT635G	Medicare PIN
WA	8942215	Other	L&I CVCP
	H75140	Medicare UPIN
TN	103I303676	Medicaid
CA	AT635E	Medicare PIN
CA	AT635K	Medicare PIN
CA	AT635O	Medicare PIN
CA	AT635W	Medicare PIN
CA	AT635Y	Medicare PIN
CO	CO307469	Medicare PIN
WA	8861683	Medicare PIN
CA	AT635L	Medicare PIN
CO	CO300478	Medicare PIN