Provider Demographics
NPI:1548887482
Name:ALLARDT FAMILY CARE LLC
Entity type:Organization
Organization Name:ALLARDT FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:KOGER
Authorized Official - Suffix:II
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:931-752-9485
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504-0190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2009 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:ALLARDT
Practice Address - State:TN
Practice Address - Zip Code:38504
Practice Address - Country:US
Practice Address - Phone:931-303-6993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care