Provider Demographics
NPI:1467648956
Name:BALCONES OBSTETRICS & GYNECOLOGY, PA
Entity Type:Organization
Organization Name:BALCONES OBSTETRICS & GYNECOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-452-8888
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 540
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-452-8888
Mailing Address - Fax:512-452-8889
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 540
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-452-8888
Practice Address - Fax:512-452-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0419207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168146204Medicaid
TX0091PNOtherBLUE CROSS BLUE SHIELD