Basic Information
Provider Information | |||||||||
NPI: | 1174727317 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ALLERGY & ASTHMA ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2359 LAKEVIEW DRIVE | ||||||||
Address2: |   | ||||||||
City: | BEAVER CREEK | ||||||||
State: | OH | ||||||||
PostalCode: | 454313695 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9374310721 | ||||||||
FaxNumber: | 9374315419 | ||||||||
Practice Location | |||||||||
Address1: | 830 WEST HIGH STREET | ||||||||
Address2: | SUITE 108 | ||||||||
City: | LIMA | ||||||||
State: | OH | ||||||||
PostalCode: | 458013971 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192270087 | ||||||||
FaxNumber: | 4192282721 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2007 | ||||||||
LastUpdateDate: | 11/13/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PARKER | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 9374310721 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |   |
ID Information
ID | Type | State | Issuer | Description | 2493449 | 05 | OH |   | MEDICAID |