Provider Demographics
NPI:1942747365
Name:BALSAM PARTNERS, PLLC
Entity Type:Organization
Organization Name:BALSAM PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:629-777-5969
Mailing Address - Street 1:203 W HIGH ST # 24
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1147
Mailing Address - Country:US
Mailing Address - Phone:629-777-5969
Mailing Address - Fax:
Practice Address - Street 1:203 W HIGH ST # 24
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1147
Practice Address - Country:US
Practice Address - Phone:629-777-5969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty