Provider Demographics
NPI: | 1932105996 |
---|---|
Name: | JOHN BALKO AND ASSOCIATES INC |
Entity Type: | Organization |
Organization Name: | JOHN BALKO AND ASSOCIATES INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICIAN OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BALKO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | AUD |
Authorized Official - Phone: | 866-758-4862 |
Mailing Address - Street 1: | 102 NORTH KEEL RIDGE ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | HERMITAGE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16148-3440 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-758-4862 |
Mailing Address - Fax: | 330-758-4886 |
Practice Address - Street 1: | 102 NORTH KEEL RIDGE ROAD |
Practice Address - Street 2: | |
Practice Address - City: | HERMITAGE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16148-3440 |
Practice Address - Country: | US |
Practice Address - Phone: | 866-758-4862 |
Practice Address - Fax: | 330-758-4886 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-06-24 |
Last Update Date: | 2013-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OE6726-T | 152W00000X |
PA | 34-00-4454D | 207Q00000X |
PA | 36-00-3012-I | 213E00000X |
PA | AT-001085-L | 231H00000X |
335E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1007545590017 | Medicaid | |
PA | 1007545590020 | Medicaid | |
OH | 2068337 | Other | MEDICAID DME OHIO |
KS | 39377011 | Other | BCBS KANSAS |
PA | 817220 | Other | BLUE CROSS |
OH | 0589118 | Other | AETNA HMO |
PA | 1500751 | Other | GATEWAY PA |
WV | 3810014011 | Medicaid | |
PA | 891755 | Other | BLUE CROSS |
WV | DO1166 | Other | RAILROAD MEDICARE |
WV | 000817313 | Other | BCBS WEST VIRGINIA |
OH | 1150680001 | Other | MEDICARE DME |
KS | DO8546 | Other | RAILROAD MEDICARE |
MI | OP11670 | Medicaid | |
0589118 | Other | AETNA | |
MO | 504036005 | Medicaid | |
000000361347 | Other | ANTHEM SENIOR ADVANTAGE | |
PA | 001547617 | Other | BLUE CROSS |
KS | 200552880A | Medicaid | |
PA | 817050 | Other | BLUE CROSS |
MO | DG3107 | Other | RAILROAD MEDICARE |
NY | 01871076 | Medicaid | |
PA | 1007545590018 | Medicaid | |
KS | 200426060A | Medicaid | |
OH | 2068337 | Medicaid | |
DB4766 | Medicare ID - Type Unspecified | RAILROAD | |
WV | 3810014011 | Medicaid | |
NY | 01871076 | Medicaid | |
MO | X180000 | Medicare PIN | |
MO | MA1949 | Medicare PIN | |
PA | 001547617 | Other | BLUE CROSS |
000000361347 | Other | ANTHEM SENIOR ADVANTAGE | |
OH | 0589118 | Other | AETNA HMO |
MO | 000015409 | Medicare PIN | |
PA | 891755 | Other | BLUE CROSS |
0589118 | Other | AETNA | |
MO | DG3107 | Other | RAILROAD MEDICARE |
OH | 1150680001 | Medicare ID - Type Unspecified | |
OH | 2068337 | Medicaid |