Provider Demographics
NPI:1124125117
Name:ALLERGY & ASTHMA CENTER PA
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAN
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:AMAR
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:254-751-1144
Mailing Address - Street 1:333 LONDONDERRY DR
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7900
Mailing Address - Country:US
Mailing Address - Phone:254-751-1144
Mailing Address - Fax:254-751-1185
Practice Address - Street 1:333 LONDONDERRY DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7900
Practice Address - Country:US
Practice Address - Phone:254-751-1144
Practice Address - Fax:254-751-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2305207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035EHOtherBCBS
TX081040002Medicaid
TXDG3056OtherRAILROAD MEDICARE
TXDG3056OtherRAILROAD MEDICARE