Provider Demographics
NPI:1952953648
Name:BALANCED MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:BALANCED MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MESSIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-283-1300
Mailing Address - Street 1:501 W OAKLAND AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1667
Mailing Address - Country:US
Mailing Address - Phone:423-283-1300
Mailing Address - Fax:423-283-1306
Practice Address - Street 1:501 W OAKLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1667
Practice Address - Country:US
Practice Address - Phone:423-283-1300
Practice Address - Fax:423-283-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty