Provider Demographics
NPI:1215119508
Name:ALLERGY ASTHMA & IMMUNOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:ALLERGY ASTHMA & IMMUNOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-638-2012
Mailing Address - Street 1:1735 ELM COURT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4129
Mailing Address - Country:US
Mailing Address - Phone:573-638-2012
Mailing Address - Fax:573-761-4249
Practice Address - Street 1:1735 ELM COURT
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-4129
Practice Address - Country:US
Practice Address - Phone:573-638-2012
Practice Address - Fax:573-761-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36946207KI0005X
MO0340248-22207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF44527Medicare UPIN
MO000013953Medicare PIN