Provider Demographics
NPI:1467003038
Name:BALA ASC
Entity Type:Organization
Organization Name:BALA ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-667-3020
Mailing Address - Street 1:1 PRESIDENTIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1015
Mailing Address - Country:US
Mailing Address - Phone:610-667-3020
Mailing Address - Fax:610-667-1817
Practice Address - Street 1:1 PRESIDENTIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1015
Practice Address - Country:US
Practice Address - Phone:610-667-3020
Practice Address - Fax:610-667-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty