Provider Demographics
NPI:1194924241
Name:NORTH TEXAS ALLERGY & ASTHMA CENTER
Entity type:Organization
Organization Name:NORTH TEXAS ALLERGY & ASTHMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEDIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-382-4142
Mailing Address - Street 1:2617 SCRIPTURE ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2311
Mailing Address - Country:US
Mailing Address - Phone:940-382-4142
Mailing Address - Fax:940-382-7620
Practice Address - Street 1:2617 SCRIPTURE STREET
Practice Address - Street 2:SUITE #101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2311
Practice Address - Country:US
Practice Address - Phone:940-382-4142
Practice Address - Fax:940-382-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6962261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13042Medicare UPIN