Basic Information
| Provider Information | |||||||||
| NPI: | 1336162908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS ALLERGY & ASTHMA CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 HIGHWAY 126 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376203310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238447000 | ||||||||
| FaxNumber: | 4238447007 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 HIGHWAY 126 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376203310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238447000 | ||||||||
| FaxNumber: | 4238447007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | WALLEN | ||||||||
| AuthorizedOfficialFirstName: | NEIL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4238447000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | MD0000017754 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
No ID Information.