Provider Demographics
NPI:1043204829
Name:ASTHMA & ALLERGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:ASTHMA & ALLERGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-0872
Mailing Address - Street 1:2709 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6231
Mailing Address - Country:US
Mailing Address - Phone:719-473-0872
Mailing Address - Fax:719-630-3658
Practice Address - Street 1:2709 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-473-0872
Practice Address - Fax:719-630-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04999082Medicaid
CO04999082Medicaid