Provider Demographics
NPI:1154439453
Name:ALLERGY AND ASTHMA SPECIALISTS PSC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA SPECIALISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:CLORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-684-6144
Mailing Address - Street 1:3604 WATHENS CROSSING
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7035
Mailing Address - Country:US
Mailing Address - Phone:270-684-6144
Mailing Address - Fax:270-684-2944
Practice Address - Street 1:3604 WATHENS CROSSING
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7035
Practice Address - Country:US
Practice Address - Phone:270-684-6144
Practice Address - Fax:270-684-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100213120Medicaid
KY000000107585OtherANTHEM BC AND BS
KY7100213120Medicaid
KY1844701Medicare PIN