Provider Demographics
NPI:1639638513
Name:ALLERGY AND ASTHMA WELLNESS CENTERS INC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA WELLNESS CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-849-1976
Mailing Address - Street 1:200 RENAISSANCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7612
Mailing Address - Country:US
Mailing Address - Phone:724-256-8514
Mailing Address - Fax:724-256-9609
Practice Address - Street 1:200 RENAISSANCE DR STE 105
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7612
Practice Address - Country:US
Practice Address - Phone:724-256-8514
Practice Address - Fax:724-256-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036269280001Medicaid