Provider Demographics
NPI:1104850718
Name:ALLERGY ASSOCIATES OF CENTRAL IN
Entity Type:Organization
Organization Name:ALLERGY ASSOCIATES OF CENTRAL IN
Other - Org Name:ALLERGY AVON
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:317-924-8208
Mailing Address - Street 1:6845 EAST US 36
Mailing Address - Street 2:SUITE 710
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-8095
Mailing Address - Fax:
Practice Address - Street 1:6845 EAST US 36
Practice Address - Street 2:SUITE 710
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-272-8095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID
IN234200Medicare ID - Type UnspecifiedMEDICARE GROUP