Provider Demographics
NPI:1568136299
Name:BALANCE REGENERATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:BALANCE REGENERATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-539-3155
Mailing Address - Street 1:1411 FALLS AVE E STE 1301
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3467
Mailing Address - Country:US
Mailing Address - Phone:208-539-3155
Mailing Address - Fax:866-507-2545
Practice Address - Street 1:1411 FALLS AVE E STE 1301
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3467
Practice Address - Country:US
Practice Address - Phone:208-539-3155
Practice Address - Fax:833-505-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty