Provider Demographics
NPI:1386026516
Name:ANDLYCO, LLC
Entity Type:Organization
Organization Name:ANDLYCO, LLC
Other - Org Name:ALL AMERICAN SCREENING & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-476-4600
Mailing Address - Street 1:1803 CENTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3598
Mailing Address - Country:US
Mailing Address - Phone:281-476-4600
Mailing Address - Fax:281-930-8856
Practice Address - Street 1:9098 CR 360
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480
Practice Address - Country:US
Practice Address - Phone:979-548-4190
Practice Address - Fax:979-548-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty