Provider Demographics
NPI:1114136561
Name:ALLEN ALLIED HEALTHCARE INC.
Entity Type:Organization
Organization Name:ALLEN ALLIED HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:423-283-9913
Mailing Address - Street 1:403 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2040
Mailing Address - Country:US
Mailing Address - Phone:423-283-9913
Mailing Address - Fax:423-283-9908
Practice Address - Street 1:403 PRINCETON RD STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2040
Practice Address - Country:US
Practice Address - Phone:423-283-9913
Practice Address - Fax:423-283-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6312173000000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723766Medicaid
TN3723766Medicare PIN
TN3723766Medicaid