Provider Demographics
NPI:1649239005
Name:KATHARINE J BALBUENA MD
Entity Type:Organization
Organization Name:KATHARINE J BALBUENA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-927-6640
Mailing Address - Street 1:PO DRAWER D
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671
Mailing Address - Country:US
Mailing Address - Phone:903-927-6640
Mailing Address - Fax:903-927-6643
Practice Address - Street 1:811 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672
Practice Address - Country:US
Practice Address - Phone:903-927-6640
Practice Address - Fax:903-927-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030QDOtherBCBS
TX029577601Medicaid
TX0030QDOtherBCBS
TX00100MMedicare PIN