Provider Demographics
NPI:1073546248
Name:ALLERGY ASSOCIATES OF CENTRAL IN
Entity Type:Organization
Organization Name:ALLERGY ASSOCIATES OF CENTRAL IN
Other - Org Name:ALLERGY COMMUNITY NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSIST EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-5460
Mailing Address - Street 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:4A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1400
Mailing Address - Country:US
Mailing Address - Phone:317-621-5460
Mailing Address - Fax:317-621-5468
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:4A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-621-5460
Practice Address - Fax:317-621-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200809930LMedicaid
IN=========OtherTAX ID
IN234200Medicare ID - Type UnspecifiedMEDICARE GROUP