Provider Demographics
NPI:1699033704
Name:JOHN C. BALCAREK MD HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:JOHN C. BALCAREK MD HEALTH SERVICES LLC
Other - Org Name:BALCAREK FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALCAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-704-7325
Mailing Address - Street 1:600 ST CLAIR
Mailing Address - Street 2:BUILDING 1, SUITE 2
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-704-7325
Mailing Address - Fax:256-270-8674
Practice Address - Street 1:600 ST. CLAIR
Practice Address - Street 2:BUILDING 1, SUITE 2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-704-7325
Practice Address - Fax:256-270-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL24129OtherSTATE OF ALABAMA MEDICAL LICENSE
AL24129OtherSTATE OF ALABAMA MEDICAL LICENSE