Provider Demographics
NPI:1992081368
Name:ALLERGY AND ASTHMA CENTER
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-255-1512
Mailing Address - Street 1:1224 PENNSYLVANIA ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7442
Mailing Address - Country:US
Mailing Address - Phone:505-255-1512
Mailing Address - Fax:505-255-1513
Practice Address - Street 1:1224 PENNSYLVANIA ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7438
Practice Address - Country:US
Practice Address - Phone:505-255-1512
Practice Address - Fax:505-255-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0747261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2121Medicare UPIN