Provider Demographics
NPI:1578531448
Name:TRI-CITIES ALLERGY CLINIC
Entity Type:Organization
Organization Name:TRI-CITIES ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALLETTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-767-1701
Mailing Address - Street 1:216 MARENGO ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6012
Mailing Address - Country:US
Mailing Address - Phone:256-767-1701
Mailing Address - Fax:256-760-0496
Practice Address - Street 1:216 MARENGO ST
Practice Address - Street 2:SUITE H
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6012
Practice Address - Country:US
Practice Address - Phone:256-767-1701
Practice Address - Fax:256-760-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL078395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty