| Bally Medical Group | |
|
1315 Route 100 Bartp PA 19504 | |
| (610) 845-2011 | |
| (610) 845-7071 |
| Full Name | Bally Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1315 Route 100, Bartp, Pennsylvania |
| Authorized Official Name and Position | Shana M Enochs (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6103274200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bally Medical Group 1315 Route 100 Bartp PA 19504 Ph: (610) 845-2011 | Bally Medical Group 1315 Route 100 Bartp PA 19504 Ph: (610) 845-2011 |
| NPI Number | 1588788996 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 07/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588788996 | NPI | - | NPPES |
| 0020170001 | Other | PA | KEYSTONE HMO |
| 026191 | Other | PA | BLUE SHIELD ASSIGN ACCT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS005855L (Pennsylvania) | Primary |