Provider Demographics
NPI:1982641353
Name:NORTHWOODS FAMILY ORTHOPAEDICS S.C.
Entity Type:Organization
Organization Name:NORTHWOODS FAMILY ORTHOPAEDICS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-561-4795
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:888-833-8200
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:502 COPPER ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1345
Practice Address - Country:US
Practice Address - Phone:715-561-4795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2002700242OtherBLUE CROSS GROUP #
WI32860600Medicaid
WI32860600Medicaid
WI=========015OtherBLUE CROSS GROUP #
WI1198950001Medicare NSC
WI32860600Medicaid
MI0N80670Medicare PIN