Provider Demographics
NPI:1568948560
Name:INTEGRATIVE HEALTH PROVIDERS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BALJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-205-2007
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-0725
Mailing Address - Country:US
Mailing Address - Phone:740-205-2007
Mailing Address - Fax:
Practice Address - Street 1:8535 REFUGEE RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9625
Practice Address - Country:US
Practice Address - Phone:740-205-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.11381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH329311Medicaid