| Balancemd | |
|
3721 Rome Dr Suite A Lafayette IN 47905-4408 | |
| (765) 807-7100 | |
| (765) 807-7101 |
| Full Name | Balancemd |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3721 Rome Dr, Lafayette, Indiana |
| Authorized Official Name and Position | Scott Sanders (PRESIDENT) |
| Authorized Official Contact | 7658077100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balancemd 3721 Rome Dr Suite A Lafayette IN 47905-4408 Ph: (765) 807-7100 | Balancemd 3721 Rome Dr Suite A Lafayette IN 47905-4408 Ph: (765) 807-7100 |
| NPI Number | 1104989011 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 10/02/2019 |
| Medicare PECOS PAC ID | 2769588151 |
|---|---|
| Medicare Enrollment ID | O20070501000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104989011 | NPI | - | NPPES |
| 000000507081 | Other | IN | ANTHEM |
| 10019219 | Other | ENCORE | |
| 9239622 | Other | CIGNA | |
| DF9084 | Other | IN | MEDICARE RR |
| 5776298 | Other | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 01045654 (Indiana) | Primary |
| Provider Name | Scott K Sanders |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902800576 PECOS PAC ID: 2668578063 Enrollment ID: I20070501000538 |
| Provider Name | Sandra M Bratton |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1407815715 PECOS PAC ID: 2668568940 Enrollment ID: I20071017000917 |
| Provider Name | Michelle a Koley |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1851593578 PECOS PAC ID: 5597834846 Enrollment ID: I20080513000487 |
| Provider Name | Stephanie E Ford |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1932244597 PECOS PAC ID: 3476622531 Enrollment ID: I20080516000071 |
| Provider Name | Ashly N Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801254081 PECOS PAC ID: 6103118963 Enrollment ID: I20160714001731 |
| Provider Name | Connor Slavich |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548876428 PECOS PAC ID: 7810362548 Enrollment ID: I20230909000091 |
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