Provider Demographics
NPI:1154607430
Name:ALLERGY AND ASTHMA EDUCATIONAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA EDUCATIONAL SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-808-1501
Mailing Address - Street 1:100 S KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6603
Mailing Address - Country:US
Mailing Address - Phone:573-777-4700
Mailing Address - Fax:844-366-3221
Practice Address - Street 1:100 S KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6603
Practice Address - Country:US
Practice Address - Phone:573-777-4700
Practice Address - Fax:844-366-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124665261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425344017Medicaid
MOP14758Medicare UPIN
MO000080790Medicare PIN