Provider Demographics
NPI:1508862673
Name:ALLERGY & ASTHMA CLINIC OF ALEXANDRIA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC OF ALEXANDRIA
Other - Org Name:LOUISIANA ALLERGY & ASTHMA SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-445-6221
Mailing Address - Street 1:201 PECAN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3361
Mailing Address - Country:US
Mailing Address - Phone:318-445-6221
Mailing Address - Fax:318-445-5399
Practice Address - Street 1:201 PECAN PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3361
Practice Address - Country:US
Practice Address - Phone:318-445-6221
Practice Address - Fax:318-445-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty