Provider Demographics
NPI:1992718290
Name:ALLERGY SINUS & ASTHMA CENTER OF LEESBURG INC
Entity type:Organization
Organization Name:ALLERGY SINUS & ASTHMA CENTER OF LEESBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-750-1999
Mailing Address - Street 1:PO BOX 1804
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1804
Mailing Address - Country:US
Mailing Address - Phone:352-750-1999
Mailing Address - Fax:352-750-1998
Practice Address - Street 1:309 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-2386
Practice Address - Country:US
Practice Address - Phone:352-750-1999
Practice Address - Fax:352-750-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8614OtherBC/BS
FL00243OtherBS/BC GROUP #
FLP00141885OtherRAILROAD MEDICARE
FLS92996Medicare UPIN
FLY8614ZMedicare ID - Type Unspecified
FLY8614OtherBC/BS