Provider Demographics
NPI:1154396760
Name:BALLEW & ASSOCIATES PODIATRY, P.A.
Entity type:Organization
Organization Name:BALLEW & ASSOCIATES PODIATRY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:254-776-6995
Mailing Address - Street 1:201 COLONNADE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6174
Mailing Address - Country:US
Mailing Address - Phone:254-779-6995
Mailing Address - Fax:254-776-5577
Practice Address - Street 1:201 COLONNADE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6174
Practice Address - Country:US
Practice Address - Phone:254-779-6995
Practice Address - Fax:254-776-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-18
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080042701Medicaid
TX00166NOtherBC/BS GROUP ID
TXCG1197OtherMEDICARE RAILROAD
TX5148350001Medicare NSC
TX00166NOtherBC/BS GROUP ID