Provider Demographics
NPI:1447598875
Name:BHUVANA BALASEKARAN MD PA
Entity Type:Organization
Organization Name:BHUVANA BALASEKARAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORENA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-570-4500
Mailing Address - Street 1:1301 W WALL ST
Mailing Address - Street 2:STE C
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6621
Mailing Address - Country:US
Mailing Address - Phone:432-570-4500
Mailing Address - Fax:432-522-2115
Practice Address - Street 1:1301 W WALL ST
Practice Address - Street 2:STE C
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6621
Practice Address - Country:US
Practice Address - Phone:432-570-4500
Practice Address - Fax:432-522-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041JJOtherBLUE CROSS BLUE SHIELD
TX153987601Medicaid
TX0041JJOtherBLUE CROSS BLUE SHIELD
TX153987601Medicaid