Provider Demographics
NPI:1487847463
Name:ALLERGY & ASTHMA CARE OF WACO, PA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CARE OF WACO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMILA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAFTARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-753-3646
Mailing Address - Street 1:221 JEWELL DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6630
Mailing Address - Country:US
Mailing Address - Phone:254-753-3646
Mailing Address - Fax:254-753-1411
Practice Address - Street 1:221 JEWELL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6630
Practice Address - Country:US
Practice Address - Phone:254-753-3646
Practice Address - Fax:254-753-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080984001Medicaid