1508062092 NPI number — ALLERY & ASTHMA ASSOCIATES

Table of content: (NPI 1508062092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508062092 NPI number — ALLERY & ASTHMA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERY & ASTHMA ASSOCIATES
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:
Provider Other Organization Name Type Code:
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:
1508062092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2359 LAKEVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER CREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45431-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-431-0721
Provider Business Mailing Address Fax Number:
937-431-5419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 WEST MCCREIGHT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-323-3585
Provider Business Practice Location Address Fax Number:
937-431-5419
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
937-431-0721

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2493387 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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