Provider Demographics
NPI:1942612759
Name:BALANCE POINT ORIENTAL MEDICINE LLC
Entity Type:Organization
Organization Name:BALANCE POINT ORIENTAL MEDICINE LLC
Other - Org Name:BALANCE POINT ORIENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:AP, LAC, DOM
Authorized Official - Phone:727-686-1092
Mailing Address - Street 1:2625 KEYSTONE RD
Mailing Address - Street 2:A2
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7436
Mailing Address - Country:US
Mailing Address - Phone:727-831-1228
Mailing Address - Fax:484-970-2380
Practice Address - Street 1:2625 KEYSTONE RD
Practice Address - Street 2:A2
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7436
Practice Address - Country:US
Practice Address - Phone:727-831-1228
Practice Address - Fax:484-970-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2317261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care