Provider Demographics
NPI:1447314778
Name:ALLERGY & ASTHMA CENTER, LLC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-835-1909
Mailing Address - Street 1:PO BOX 7190
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-7190
Mailing Address - Country:US
Mailing Address - Phone:256-835-1909
Mailing Address - Fax:256-835-1610
Practice Address - Street 1:912 SNOW ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1214
Practice Address - Country:US
Practice Address - Phone:256-835-1909
Practice Address - Fax:256-835-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDN4865OtherRAILROAD MEDICARE
AL529900520Medicaid
AL51045597OtherBLUECROSS AND BLUESHIELD
AL000045597Medicaid
AL529900520Medicaid
AL000045597Medicaid