Provider Demographics
NPI:1407805468
Name:ALLERGY CARE CENTER
Entity Type:Organization
Organization Name:ALLERGY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUTSON-FINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-521-3363
Mailing Address - Street 1:2100 N GREEN ACRES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2807
Mailing Address - Country:US
Mailing Address - Phone:479-521-3363
Mailing Address - Fax:479-521-4167
Practice Address - Street 1:2100 N GREEN ACRES RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2807
Practice Address - Country:US
Practice Address - Phone:479-521-3363
Practice Address - Fax:479-521-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCS3629OtherCLINIC RAILROAD MC #
AR57177OtherCLINIC BCBS PROV #
AR57177OtherCLINIC BCBS PROV #