1629159538 NPI number — THE ALLERGY CENTER AT BROOKSTONE PC

Table of content: (NPI 1629159538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629159538 NPI number — THE ALLERGY CENTER AT BROOKSTONE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ALLERGY CENTER AT BROOKSTONE 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:
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:
1629159538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 BROOKSTONE CENTRE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-324-4012
Provider Business Mailing Address Fax Number:
706-324-0396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 BROOKSTONE CENTRE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-324-4012
Provider Business Practice Location Address Fax Number:
706-324-0396
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRZANOWSKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
706-324-4012

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: 535026 . This is a "BCBS HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60036871 . This is a "BCBS AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258780808 . This is a "CHAMP VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258780808 . This is a "TRICARE PRIME REGION 3" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS AL ALL KIDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS GA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000635203H . This is a "PEACH STATE HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS AL GA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS FED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535026 . This is a "BCBS GA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60036834 . This is a "BCBS AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00635203H . This is a "PEACHCARE FOR KIDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258780808 . This is a "TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258780808 . This is a "TRICARE STANDARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 535025 . This is a "STATE HEALTH BENEFIT P" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00172885 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 304868 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60036873 . This is a "BCBS AL" identifier . This identifiers is of the category "OTHER".




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