Provider Demographics
NPI:1457309635
Name:ALLERGY & ASTHMA CONSULTANTS OF THE OZARKS LTD
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CONSULTANTS OF THE OZARKS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FERN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-368-7000
Mailing Address - Street 1:1233 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2409
Mailing Address - Country:US
Mailing Address - Phone:573-634-7000
Mailing Address - Fax:573-634-3120
Practice Address - Street 1:509 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3302
Practice Address - Country:US
Practice Address - Phone:573-368-7000
Practice Address - Fax:573-364-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000004944OtherMEDICARE PTAN
MO500076609Medicaid
MO000003203OtherMEDICARE PTAN
MO000004653OtherMEDICARE PTAN
MO990001008Medicare PIN
MO000004944OtherMEDICARE PTAN
990001003Medicare PIN