| Balsam Health Of The Carolinas, Pllc | |
|
607 W Grover St Ste 101 Shelby NC 28150-2816 | |
| (704) 866-0101 | |
| (704) 866-0103 |
| Full Name | Balsam Health Of The Carolinas, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 607 W Grover St Ste 101, Shelby, North Carolina |
| Authorized Official Name and Position | Radwan Ibrahim (OWNER/MEMBER) |
| Authorized Official Contact | 7049414485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balsam Health Of The Carolinas, Pllc Po Box 6449 Concord NC 28027-1525 Ph: (704) 866-0101 | Balsam Health Of The Carolinas, Pllc 607 W Grover St Ste 101 Shelby NC 28150-2816 Ph: (704) 866-0101 |
| NPI Number | 1598257750 |
|---|---|
| Provider Enumeration Date | 06/04/2018 |
| Last Update Date | 06/04/2018 |
| Medicare PECOS PAC ID | 4789927336 |
|---|---|
| Medicare Enrollment ID | O20190522001208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598257750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 9701414 (North Carolina) | Primary |
| Provider Name | Elizabeth B Scism |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760647127 PECOS PAC ID: 7810063336 Enrollment ID: I20080908000378 |
| Provider Name | Radwan A Ibrahim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497740682 PECOS PAC ID: 8921243403 Enrollment ID: I20130404000357 |
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