Provider Demographics
NPI:1407254055
Name:ALLIED HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:ALLIED HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TKHILAISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-302-3343
Mailing Address - Street 1:21 SCHOOL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6640
Mailing Address - Country:US
Mailing Address - Phone:617-302-3343
Mailing Address - Fax:
Practice Address - Street 1:21 SCHOOL ST
Practice Address - Street 2:STE 1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6640
Practice Address - Country:US
Practice Address - Phone:617-302-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service