Provider Demographics
NPI:1699867101
Name:FAMILY ALLERGY SERVICES, INC.
Entity type:Organization
Organization Name:FAMILY ALLERGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEVEDON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-4222
Mailing Address - Street 1:330 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7820
Mailing Address - Country:US
Mailing Address - Phone:606-324-4222
Mailing Address - Fax:606-324-4332
Practice Address - Street 1:330 25TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7820
Practice Address - Country:US
Practice Address - Phone:606-324-4222
Practice Address - Fax:606-324-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24374261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1472801Medicare ID - Type Unspecified