Provider Demographics
NPI:1609554534
Name:PHILLIP BALFANZ, MD PLLC
Entity Type:Organization
Organization Name:PHILLIP BALFANZ, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BALFANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-538-0127
Mailing Address - Street 1:123 COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4951
Mailing Address - Country:US
Mailing Address - Phone:830-538-0127
Mailing Address - Fax:
Practice Address - Street 1:123 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4951
Practice Address - Country:US
Practice Address - Phone:830-538-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty