Provider Demographics
NPI:1245599174
Name:REMOTE ALLERGY PROVIDERS P.C.
Entity Type:Organization
Organization Name:REMOTE ALLERGY PROVIDERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-632-4050
Mailing Address - Street 1:1562 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-6731
Mailing Address - Country:US
Mailing Address - Phone:541-632-4050
Mailing Address - Fax:
Practice Address - Street 1:1890 7TH ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-9826
Practice Address - Country:US
Practice Address - Phone:541-632-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850048NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty