Provider Demographics
NPI:1477522175
Name:BALAS HOESLEY, MANCI M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANCI
Middle Name:M
Last Name:BALAS HOESLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANCI
Other - Middle Name:M
Other - Last Name:BALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3735 CORPORATE WOODS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2296
Mailing Address - Country:US
Mailing Address - Phone:205-900-7337
Mailing Address - Fax:855-583-3156
Practice Address - Street 1:3735 CORPORATE WOODS DR STE 105
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35242-2296
Practice Address - Country:US
Practice Address - Phone:205-900-7337
Practice Address - Fax:855-583-3156
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051022734OtherBLUE SHIELD
AL303730278Medicaid
AL051519831OtherBLUE SHIELD
AL303720278Medicaid
AL303740278Medicaid
AL051034755OtherBLUE SHIELD
AL051539291OtherBLUE SHIELD
AL051034754OtherBLUE SHIELD
AL303790278Medicaid
AL051022734OtherBLUE SHIELD
AL303710278Medicaid
AL303720278Medicaid
AL051519831OtherBLUE SHIELD