Balanced Vitality LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

BALANCED VITALITY LLC

Practice address

1125 E 2ND St
Casper, WY 82601-2903

Phone

(307) 577-4225

Fax

(307) 577-4229

NPI assigned

Aug 15, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debbie Porter

Title

Office Manager

Phone

(307) 577-4225

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1306574520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E 2ND ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012903",
            "telephone_number": "307-577-4225",
            "fax_number": "307-577-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E 2ND ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012903",
            "telephone_number": "307-577-4225",
            "fax_number": "307-577-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED VITALITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "307-577-4225"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477894756",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013083740",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John D Bailey, MD
• Marcus John Bailey
• Paige Elizabeth Bailey
• Charity Lynn Baker
• Ismaeel Mohamed Bakhsh, M.D.
• Cristian Adrian Balcescu, MD
• Kevin Baldwin, PT, DPT
• Camden Ballard-Betancourt
• Steven S Bang
• Banner Health

• Health Service Clinic/Center in Casper, WY
• Providers in Casper, WY by specialty
• Health Service Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.