Provider Demographics
NPI:1891853271
Name:BALANCED MEDICINE LLC
Entity Type:Organization
Organization Name:BALANCED MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-746-0453
Mailing Address - Street 1:29002 ROCKSTULL RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-9644
Mailing Address - Country:US
Mailing Address - Phone:740-746-0453
Mailing Address - Fax:740-743-0453
Practice Address - Street 1:29002 ROCKSTULL RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:OH
Practice Address - Zip Code:43155-9644
Practice Address - Country:US
Practice Address - Phone:740-746-0453
Practice Address - Fax:740-743-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007781S261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335351Medicaid
OHH60106Medicare UPIN