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 | 36-00-3012-I | 213E00000X |
| PA | AT-001085-L | 231H00000X |
| 335E00000X | ||
| PA | 34-00-4454D | 207Q00000X |
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 |
