1912084807 NPI number — ALLERGY, ASTHMA & IMMUNOLOGY, PC

Table of content: (NPI 1912084807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912084807 NPI number — ALLERGY, ASTHMA & IMMUNOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY, ASTHMA & IMMUNOLOGY, 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:
1912084807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7205 ROTHERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-7415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-588-8508
Provider Business Mailing Address Fax Number:
865-588-8057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1114 E WEISGARBER RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-588-1833
Provider Business Practice Location Address Fax Number:
865-588-8057
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
865-588-8508

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 68256 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 31655207 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com