Provider Demographics
NPI:1639410954
Name:BALCH INTERVENTIONAL PAIN AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:BALCH INTERVENTIONAL PAIN AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JUDSON
Authorized Official - Last Name:BALCH
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:817-984-6210
Mailing Address - Street 1:4319 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3893
Mailing Address - Country:US
Mailing Address - Phone:817-984-6210
Mailing Address - Fax:817-984-6216
Practice Address - Street 1:4319 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3893
Practice Address - Country:US
Practice Address - Phone:817-984-6210
Practice Address - Fax:817-984-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX277799Medicare PIN