Provider Demographics
NPI:1194861641
Name:ALLERGY & ASTHMA CARE AND PREVENTION CENTERS, LLC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CARE AND PREVENTION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:AVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-706-9923
Mailing Address - Street 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-706-9923
Mailing Address - Fax:303-706-0904
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-706-9923
Practice Address - Fax:303-706-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR16544207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08523231Medicaid
CO08523231Medicaid