Provider Demographics
NPI:1265434740
Name:SALLY K BALIN AMBULATORY SURGICAL CENTER INC
Entity type:Organization
Organization Name:SALLY K BALIN AMBULATORY SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-565-3300
Mailing Address - Street 1:110 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1755
Mailing Address - Country:US
Mailing Address - Phone:610-892-0300
Mailing Address - Fax:610-565-9909
Practice Address - Street 1:110 CHESLEY DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1755
Practice Address - Country:US
Practice Address - Phone:610-892-0300
Practice Address - Fax:610-565-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09421500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATH020119Medicare ID - Type Unspecified