1386606911 NPI number — ALLERGY & ASTHMA CENTER, PC

Table of content: (NPI 1386606911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386606911 NPI number — ALLERGY & ASTHMA CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY & ASTHMA CENTER, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE ALLERGY AND ASTHMA CENTER, PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386606911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7222 ENGLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46804-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-432-5005
Provider Business Mailing Address Fax Number:
260-432-6003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7222 ENGLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-432-5005
Provider Business Practice Location Address Fax Number:
260-432-6003
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
JANEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
260-432-5005

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  50003931A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22000000104747 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000005309 . This is a "M-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200234350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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