Organization Active NPI

Tri City Balance Center S.C.

  • Neurology Physical Therapist
  • Geneva, IL
National Provider Identifier
1649306267
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology Physical TherapistTaxonomy code 2251N0400X
Legal business name
TRI CITY BALANCE CENTER S.C.
Practice address
302 Randall Rd # 104-a
Geneva, IL 60134-4209
Phone
(630) 845-3177
Fax
(630) 377-4023
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Ronald B Bukowy, MD
Title
Medical Director
Phone
(630) 377-4020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251N0400X Primary

Addresses

Primary practice location

302 Randall Rd # 104-a
Geneva, IL 60134-4209

Mailing address

302 Randall Rd # 104-a
Geneva, IL 60134-4209
Phone (630) 845-3177

Other identifiers 1

IdentifierTypeStateIssuer
BCBSOtherIL04532303

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1649306267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 RANDALL RD # 104-A",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344209",
            "telephone_number": "630-845-3177",
            "fax_number": "630-377-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 RANDALL RD # 104-A",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344209",
            "telephone_number": "630-845-3177",
            "fax_number": "630-377-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI CITY BALANCE CENTER S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BUKOWY",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "630-377-4020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "04532303",
            "identifier": "BCBS",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.