Provider Demographics
NPI:1750453163
Name:ALLERGY & ASTHMA CENTER, PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-300-4882
Mailing Address - Street 1:20 FOUR MILE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2644
Mailing Address - Country:US
Mailing Address - Phone:406-300-4882
Mailing Address - Fax:406-257-2706
Practice Address - Street 1:95 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2613
Practice Address - Country:US
Practice Address - Phone:406-300-4882
Practice Address - Fax:406-257-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083688Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER