Provider Demographics
NPI:1376513515
Name:ALLERGY CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:ALLERGY CENTERS OF AMERICA LLC
Other - Org Name:ACA LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PITOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-9838
Mailing Address - Street 1:190 CHARLOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1522
Mailing Address - Country:US
Mailing Address - Phone:336-760-9838
Mailing Address - Fax:336-760-5275
Practice Address - Street 1:190 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1522
Practice Address - Country:US
Practice Address - Phone:336-760-9838
Practice Address - Fax:336-760-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory